Imaging in the staging of renal cell carcinoma

Imaging is extremely important in determining the type of surgery undertaken in patients with proven renal cell carcinoma. In this review, the strength and limitations of each of the relevant techniques are outlined, highlighting particularly the correlation between the imaging findings and the pathological staging. Over the past decade, CT has become the most widely used technique for staging renal cell carcinoma, partly due to the very high overall accuracy of up to 90% that has been achieved. MRI appears to have a similar overall accuracy to CT, whereas ultrasound is less accurate than CT or MRI in the overall staging of tumours. However, ultrasound is extremely accurate in identifying and localising the clinically important tumour extension into the intra-hepatic vena cava and right atrium and if local surgical practice requires only a knowledge of venous invasion, a technically adequate ultrasound examination may suffice. All techniques are unreliable in detecting early perinephric spread.