Department of Radiology, Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen, Ziemssenstrasse 1, 80336, Munich, Germany.
World J Urol. 2010 Jun;28(3):253-61. doi: 10.1007/s00345-010-0557-z. Epub 2010 May 11.
To describe current radiological cross-sectional imaging in the detection and staging of advanced renal cell carcinoma (RCC), defined here as RCC reaching beyond the renal capsule, whether by immediate extension or by metastasis.
Review and summary of current radiological and urological literature, including original articles and reviews, retrieved from the medical data base "PubMed".
Multi-detector-row computed tomography (MDCT) shows a sensitivity of up to 100% and specificity of about 90% for retroperitoneal disease, venous tumour thrombus, and metastasis, but limited accuracy for lymphadenopathy in RCC. Magnetic resonance imaging (MRI) is applied as a problem-solving modality, with particular strength in imaging metastasis to brain and bone. However, dynamic, contrast-enhanced- (DCE-) and arterial-spin-labelling (ASL-) MRI may help to monitor early response to angiogenesis inhibitor drugs. Ultrasonography (US) shows limited capability of identifying retroperitoneal disease, venous tumour thrombus extension, and metastasis. Positron Emission Tomography with 18-fluoro-desoxy-glucose (FDG-PET) demonstrates modest accuracy for metastasis of RCC, with positive studies being suspicious, while negative studies cannot reliably exclude disease.
MDCT represents the diagnostic mainstay for the detection and staging of RCC. In the wake of new systemic therapies for advanced RCC, including angiogenesis inhibitor drugs, monitoring treatment response may become a new task for cross-sectional imaging.
描述目前在检测和分期晚期肾细胞癌（RCC）中的影像学横断面成像，这里定义的晚期 RCC 是指已经超出了肾包膜的 RCC，无论是直接延伸还是转移。
对来自医学数据库“PubMed”的当前影像学和泌尿科文献进行综述和总结，包括原始文章和综述。
多排螺旋 CT（MDCT）对腹膜后疾病、静脉肿瘤血栓和转移的检测具有高达 100%的敏感性和约 90%的特异性，但对 RCC 淋巴结病的准确性有限。磁共振成像（MRI）作为一种解决问题的方式应用，在成像脑和骨转移方面具有特别的优势。然而，动态对比增强（DCE）和动脉自旋标记（ASL）MRI 可能有助于监测抗血管生成抑制剂药物的早期反应。超声（US）对识别腹膜后疾病、静脉肿瘤血栓延伸和转移的能力有限。正电子发射断层扫描（PET）与 18-氟去氧葡萄糖（FDG-PET）结合使用，对 RCC 转移的准确性适中，阳性研究可疑，而阴性研究不能可靠地排除疾病。
MDCT 是检测和分期 RCC 的主要诊断方法。随着新的系统治疗方法在晚期 RCC 中的应用，包括抗血管生成抑制剂药物，对治疗反应的监测可能成为影像学横断面成像的一个新任务。
