Case Report
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World J Radiol. Nov 28, 2013; 5(11): 436-445
Published online Nov 28, 2013. doi: 10.4329/wjr.v5.i11.436
MDCT imaging following nephrectomy for renal cell carcinoma: Protocol optimization and patterns of tumor recurrence
Stephanie F Coquia, Pamela T Johnson, Sameer Ahmed, Elliot K Fishman
Stephanie F Coquia, Pamela T Johnson, Sameer Ahmed, Elliot K Fishman, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
Author contributions: Coquia SF selected cases from database and performed writeup; Johnson PT, Ahmed S, Fishman EK compiled database of cases and reviewed paper.
Correspondence to: Stephanie F Coquia, MD, Department of Radiology, Johns Hopkins Hospital, JHOC 3142, 601N Caroline Street, Baltimore, MD 21287, United States. sfcst6@yahoo.com
Telephone: +1-410-9558540 Fax: +1-410-6149865
Received: June 30, 2013
Revised: August 19, 2013
Accepted: August 28, 2013
Published online: November 28, 2013
Processing time: 151 Days and 8.2 Hours
Abstract

The purpose of this pictorial essay is to review the common and uncommon sites of renal cell carcinoma recurrence throughout the body by examining their appearances on computerized tomography (CT). CT imaging protocols will be discussed. The sites of recurrence have been categorized into 4 groups: chest and mediastinum, abdomen and pelvis, musculoskeletal, and neurological. For each site of recurrence, a representative CT image correlate with discussion is provided. The unique CT appearance of renal cell carcinoma recurrence and how it can be used in lesion detection will be discussed. Renal cell carcinoma recurrences are hypervascular like the primary tumor, which can aid in not only lesion detection but also in some cases, differentiation from other primary tumors. Through CT case review of various sites of recurrence, lesions are shown to be easily seen on arterial phase while sometimes being nearly inconspicuous on venous or delayed phases. Coronal and sagittal reconstructions can also improve diagnostic sensitivity. CT is the most commonly used imaging tool for surveillance of renal cell carcinoma recurrence after nephrectomy. Knowledge of sites of recurrence as well as the utility of arterial phase imaging and multiplanar reconstructions will aid in optimizing detection of disease recurrence.

Keywords: Renal cell carcinoma; Recurrence; CT; Metastasis; Diagnosis

Core tip: The computerized tomography (CT) imaging appearance of renal cell carcinoma recurrence mimics the appearance of the primary tumor. Just as a majority of renal cell carcinomas are hypervascular, recurrences tend to be hypervascular and are best seen on arterial phase. This paper demonstrates this tendency by giving case examples which review both common and uncommon sites of recurrence. Knowledge of their appearances on CT will help the radiologist in lesion detection and diagnosis, limiting delays in treatment and avoiding unnecessary biopsies.