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RENAL MASS IMAGING: CURRENT TECHNIQUES & ADVANCEMENTS Rajan T. Gupta, M.D. Leading Edge Urology: DUA 2017

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Page 1: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RENAL MASS IMAGING: CURRENT TECHNIQUES &

ADVANCEMENTS

Rajan T. Gupta, M.D.

Leading Edge Urology: DUA 2017

Page 2: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Disclosures Bayer Pharma AG

Consultant Speakers Bureau

Invivo Corp. Consultant

Halyard Health Consultant

Siemens AG Consultant

Page 3: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Introduction

Brief Overview of CT Protocols to optimize detection and characterization of primary and metastatic disease

Cases Renal Cell Carcinoma Miscellaneous GU Tumors

Subtyping RCC based on imaging?

Page 4: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

OPTIMIZING CT PROTOCOLS

Page 5: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Modalities CT Protocols Standard CAP (Portal venous phase)

• Prostate CA • Lung CA

Dual Liver Protocol • Breast CA • Neuroendocrine tumors • Carcinoid

Urology Specific Protocols

Page 6: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Modalities Genitourinary Protocol

Indications: • Hematuria • Suspected renal mass • Evaluation of ureters

Noncontrast Phase Imaging • Precontrast attenuation of masses • Calcifications

Nephrographic Phase Imaging • Maximum lesion conspicuity

Delayed Phase Imaging • Filling defects in collecting systems, ureters, urinary bladder

Page 7: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Modalities RCC Protocol Indications:

• Follow up for patients with known RCC

Noncontrast Phase Imaging • Precontrast attenuation of masses • Calcifications

Dual Liver Imaging • Arterial phase due to hypervascular nature of RCC

and its metastases • Portal venous phase for overall lesion detection

Page 8: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Modalities TCC Protocol Indications:

• Follow up for patients with known TCC

Noncontrast Phase Imaging • Precontrast attenuation of masses • Calcifications

Split Bolus • Portal venous phase for overall lesion detection • Delayed phase for filling defects

Decreased radiation dose overall

Page 9: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RENAL CELL CARCINOMA

Page 10: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Background – RCC

#1 most common solid neoplasm of kidney 3% adult malignancies 90-95% malignancies of kidney

USA ~40K cases in 2007 (67% male) ~9K deaths in 2007

Worldwide >100K deaths in 2001

Page 11: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Background – RCC

Increased diagnosis in patients without clinical symptoms

“Classic Triad” occurs in 10% Flank Pain (40%) Hematuria (40%) Flank Mass (25%)

30% present with metastatic disease

Page 12: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Background – RCC

Risk Factors Cigarette Smoking

• Factor in 33% cases Obesity HTN Phenacetin Acquired cystic disease of HD

Page 13: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Background – RCC

Two probable mechanisms for arising De novo from solid adenomatous rests From epithelial lining of a cyst

Also, clustered cases with hereditary syndromes

Page 14: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Background – RCC

Associated with hereditary conditions Von Hippel Lindau

• Autosomal dominant • Multiple cysts with papillary tufts • Risk of early, bilateral, and multiple

RCCs • Requires yearly screening

Page 15: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Background – RCC Assoc w/ hereditary conditions (cntd) Tuberous Sclerosis

• Slightly increased risk of RCC • 2-4% of TS patients Sickle Cell Trait

• Renal Medullary Carcinoma –Aggressive, malignant variant –Poor prognosis –Young Patients

Page 16: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Diagnosis

Diagnosis of RCC has changed Previously, dx on ultrasound, excretory

urograms, etc. Mainstay of diagnosis today is CT Allows for lesion characterization Evaluation of distant mets Evaluation of vascular patency

Page 17: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Diagnosis – US

Ultrasound Findings Solid mass

• Can help with DDx of solid vs cystic masses

Vascularity Venous Invasion Adjacent LNs

Page 18: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Diagnosis – CT

CT Findings Enhancement

• Precontrast phases are critical • 10-15 HU = “pseudoenhancement” • >15 HU = enhancement Fat

• Angiomyolipoma?

Page 19: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Diagnosis – MR

MRI Good for patients with contrast allergy Good for vascular evaluation,

specifically IVC and RV involvement Similar to CT

Page 20: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Solid Mass – DDx

Renal Cell CA Oncocytoma Angiomyolipoma Transitional Cell CA Hematoma in setting of trauma Metastases Lymphoma

Page 21: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Which is malignant?

Similar age patients, both masses enhance

Page 22: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Which is malignant?

Oncocytoma Renal Cell CA

Page 23: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Most Solid Masses – DDx (in reality)

Renal Cell CA Renal Cell CA Renal Cell CA Renal Cell CA Renal Cell CA Renal Cell CA Everything else…

Page 24: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RENAL CELL CA – STAGING

Page 25: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Staging Systems

Robson Simple Clinically Relevant and Useful

TNM AJCC Endorsed More complex

Page 26: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

http://www.beatrcc.com/wp-content/uploads/2009/07/carcinoma-color-staging.gif

Page 27: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Staging Systems

Disadvantage of Robson system IIIA – invasion of RV, IVC IIIB – Regional LN involvement IIIC – Both

IIIA has markedly better survival rates than IIIB, and not significantly different from II

Page 28: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Renal Cell Carcinoma

Distant organ metastases Lungs 55% Liver 25% Bones 20% Adrenal 20% Contralateral kidney 10% Other organs <5%

Page 29: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC CASE 1

Page 30: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
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Page 33: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 1 RCC with IVC invasion

Page 34: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC CASE 2

Page 35: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 36: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 37: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 2 RCC with necrotic

lymphadenopathy

Page 38: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 3 Hx of RCC

s/p L nephrectomy

Page 39: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
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Page 42: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 3 Local and distant

disease recurrence

Page 43: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC CASE 4

Page 44: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 45: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 46: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 47: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 4 Multiple RCC IVC invasion

Page 48: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC CASE 5

Page 49: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 50: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

24 HU

Page 51: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 52: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

60 HU

Page 53: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CT guided percutaneous bx

Page 54: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

s/p partial nephrectomy

Page 55: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 5 Solid enhancing RCC

s/p partial nephrectomy

Page 56: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC CASE 6

Page 57: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 58: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
Page 59: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 6 Large RCC with mass effect

on but no invasion of IVC

Page 60: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC CASE 7

Page 61: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship
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CASE 7 L RCC s/p R nephrectomy with hypervascular nodal

and pancreatic mets

Page 64: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 8

Page 65: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

38 yo male with hematuria

Page 66: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

6 weeks of abx, no improvement…now what?

Page 67: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Additional clinical history: sickle cell…diagnosis?

Page 68: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 8 Renal Medullary CA

Hx of sickle cell (TCC mimic in kidney)

Page 69: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

CASE 9

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CASE 9 Left TCC on MRI

Page 73: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

SUBTYPING RCC USING IMAGING

Page 74: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Subtyping RCC Clear Cell RCC

“Clear” cells with abundant intracytoplasmic lipid/glycogen with intervening small blood vessels

Large size, necrosis and intravascular extension into the renal vein and IVC are common

Papillary RCC Papillary architecture consisting of cuboidal cells with

granular cytoplasm covering a fibrovascular core Foamy macrophages and intracellular hemosiderin common Type 1 (basophilic) > Type 2 (eosinophilic) (better prognosis) On NECT, pRCC can appear mildly hyperdense Smaller tumors are relatively homogeneous and are typically

hypovascular Courtesy of Brian Allen, M.D.

Page 75: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Clear Cell Carcinoma (ccRCC) Clear cells filled with lipid & glycogen

Courtesy of Brian Allen, M.D.

Page 76: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Features of ccRCC Viable components enhance avidly +/- necrosis Microscopic lipid is detected in up to 40% and has

PPV for ccRCC of ≥ 95%

OP

IP

Courtesy of Brian Allen, M.D.

Page 77: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Features of ccRCC

Corticomedullary Delayed Courtesy of Brian Allen, M.D.

Page 78: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Features of ccRCC

T2 T1 iso CM Neph

Courtesy of Brian Allen, M.D.

Page 79: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Imaging Features of ccRCC

T2 T1 CM Neph

Note: Not all ccRCC have evidence of intracellular lipid on MRI

Courtesy of Brian Allen, M.D.

Page 80: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Papillary Carcinoma (pRCC) Papillary architecture with dark

staining hemosiderin Unenhanced (50HU) 65 HU 85 HU

Courtesy of Brian Allen, M.D.

Page 81: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

MR Imaging Features of pRCC On MR, pRCC is typically iso on T1w, T2w and

enhances less than renal parenchyma

Corticomedullary T2 ssFSE

Courtesy of Brian Allen, M.D.

Page 82: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

MR Imaging Features of pRCC Pitfall: Other tumors, such as AML, TCC, and

lymphoma can also appear hypointense on T2w

Corticomedullary T2 ssFSE

Courtesy of Brian Allen, M.D.

Page 83: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

MR Imaging Features of pRCC Hemosiderin may be seen as areas of signal loss

(susceptibility) on longer TE in-phase images

Opposed Phase In Phase

Courtesy of Brian Allen, M.D.

Page 84: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

RCC Summary

CT = mainstay of RCC imaging Diagnosis Follow-up

“All that glitters is not gold…but most of it is”

Renal solid mass DDx starts and ends with RCC but other entities do occur

Subtyping of RCC is possible on imaging, especially MRI

Page 85: Leading Edge Urology: DUA 2017 RENAL MASS IMAGING: … · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

THANK YOU

Rajan T. Gupta, M.D. Associate Professor of Radiology

Assistant Professor of Surgery Director, Abdominal Imaging Fellowship

Duke University Medical Center Duke Cancer Institute

[email protected]

Leading Edge Urology: DUA 2017