What is the role of imaging studies in the preoperative evaluation for radical nephrectomy?

Updated: Feb 05, 2019
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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  • For patients with bone pain or elevated serum alkaline phosphatase levels, a bone scan is also sometimes required, along with chest radiography and abdominal CT scanning.

  • If involvement of the inferior vena cava is suspected, MRI is performed to demonstrate the presence and the distal extent of inferior vena caval involvement.

  • CT scanning is an important part of the presurgical evaluation of the renal tumor (see image below). It yields good accuracy in evaluating the tumor size, location, and any invasion of renal collecting system or perirenal fat. The anatomy of the contralateral kidney is also evaluated. CT scan correctly reveals renal vein involvement in 82-95% of cases and vena caval involvement in 95-100% of cases. If the status of the veins is in doubt after CT scanning is performed, venography should be performed. Abdominal and pelvic CT scanning is performed with and without contrast unless the renal function is impaired or the patient has a contrast allergy. Chest CT scanning is performed for all cases in some centers. Other centers perform the study only when the chest radiography findings are abnormal or when the patient has respiratory symptoms.

    CT finding that confirms a huge right renal mass. CT finding that confirms a huge right renal mass.
  • Renal arteriography, although no longer routinely necessary before performing radical nephrectomy, is useful in showing arterialization of a tumor thrombus. However, arteriography may be supplanted by magnetic resonance angiography (MRA) and the even newer CT angiography techniques.

  • Transesophageal echocardiography can be used to assess vena caval tumor thrombi. It is accurate but invasive and costly and has no diagnostic advantage over MRI in the preoperative evaluation of these patients. [6]

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