Pre- and Post-Treatment Imaging of Renal Cell Carcinoma: Can Imaging Predict Histology?

摘要

It is estimated that there were 64,770 new cases of renal cell carcinoma (RCC) and 13,517 deaths in the United States in the year 2012. RCC is a heterogeneous group of diseases with multiple subtypes that have unique histologic appearances, genetic expression, molecular profile, and biologic behavior. The most common subtype of RCC is clear cell RCC (70%-75%), followed by papillary RCC (10%-15%), and chromophobe RCC (5%-10%). Medullary carcinoma, collecting duct carcinoma, mucinous tubular and spindle cell carcinoma, Tubulocystic RCC, Xp translocation RCC, and unclassified RCCs are among other uncommon subtypes that constitute the reminder of the cases of RCC. Different histologies have different molecular pathways of ontogenesis, and advances in molecular genetics and therapeutics have provided an opportunity to develop targeted therapies in patients even with metastatic RCCs. The efficacy of such therapy depends on accurate histologic subtyp-ing of tumors. With the evolution of modern cross-sectional imaging methods, it is now not only possible to characterize and stage these tumors, but also to identify the subtypes noninvasively. A combination of analysis of appearances of tumors based on first principles of location and pattern of growth, degree and pattern of enhancement, use of functional MRI technique such as dynamic contrast-enhanced MRI, diffusion-weighted imaging, and arterial spin labeling are some of the tools available.