Preliminary Diagnosis: Renal Cell Carcinoma
I. What imaging technique is first-line for this diagnosis?
Gray scale and Color Doppler sonographic evaluation of the kidneys.
II. Describe the advantages and disadvantages of this technique for diagnosing renal cell carcinoma.
Advantages
- Highly portable and a relatively inexpensive imaging modality.
- Does not expose patients to ionizing radiation.
- Details the vascularity of renal lesions with great sensitivity and specificity.
- May help guide treatment.
Disadvantages
- Less adept in detailing any abnormally enhancing soft tissue component as compared to other imaging modalities.
- Less adept in detailing and characterizing the surrounding anatomical structures as compared to other imaging modalities.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications exist.
IV. What alternative imaging techniques are available?
- CT of the abdomen and pelvis with IV contrast.
- MR of the abdomen and pelvis with IV contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing renal cell carcinoma.
CT of the abdomen and pelvis with IV contrast
Advantages
- Highly sensitive and specific in detecting and characterizing renal lesions.
- Offers exquisite detail of any enhancing soft tissue components.
- May help guide treatment and therapy.
Disadvantages
- Exposes patients to ionizing radiation.
- Less portable than ultrasound.
MR of the abdomen and pelvis with IV contrast
Advantages
- Highly specific in characterizing the fluid within the renal cysts.
- Highly adept in characterizing any abnormally enhancing soft tissue components.
- Does not expose patients to ionizing radiation.
Disadvantages
- Expensive.
- Time consuming.
- May be subject to motion artifact and susceptibility weighted artifact, degrading image quality.
- Less adept in guiding therapy and treatment than ultrasound.
VI. What are the contraindications for the alternative imaging techniques?
CT of the abdomen and pelvis with IV contrast
- May be contraindicated in pregnant patients.
- Relative contraindication in patients with renal failure or contrast allergy.
MR of the abdomen and pelvis with IV contrast
- May be contraindicated in patients with non-MR compatible hardware.
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