Renal Cell Carcinoma: Preoperative Assessment for Enucleative Surgery with Angiography, CT, and MRI

PURPOSE: Our purpose was to assess various imaging methods in detecting a pseudocapsule of renal cell carcinoma (RCC), which is critical for successful tumor enucleation. METHOD: In 42 patients with histopathologically proven RCC, images obtained at angiography (n = 42), CT (n = 30), and MRI (n = 19) were investigated retrospectively. All patients underwent treatment (enucleation: n = 15; nephrectomy: n = 27). The imaging criteria for the presence of a pseudocapsule were as follows: a surrounding radiolucent rim on angiography, a low or high density rim on CT, and a low intensity rim on MRI. All images were retrospectively reviewed by three radiologists without knowledge of the clinical and histological findings. RESULTS: Thirty-three of 42 RCCs showed a pseudocapsule on the surgical specimen. A pseudocapsule was detected in 67% of tumors (22/33) on angiography, 26% (6/23) on CT, 27% (4/15) on T1-weighted MRI, 93% (14/15) on T2-weighted MRI, 67% (8/12) on dynamic enhanced T1-weighted MRI, and 15% (2/13) on delayed enhanced T1-weighted MRI. CONCLUSION: T2-weighted MR images are superior for visualizing a pseudocapsule of RCC and for providing reliable selection criteria for tumor enucleation.