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CT is the most widely used modality for renal mass evaluation, offering broad availability, high spatial resolution, and multiphasic acquisition. This comprehensive narrative review summarizes current evidence on CT-based characterization of renal cell carcinoma, radiologic\u2013pathologic correlation, imaging markers of tumor aggressiveness, renal mass biopsy, and radiomics. Radiomics and other quantitative imaging approaches may complement conventional imaging by capturing tumor heterogeneity and biologically relevant features; however, most studies remain retrospective, single-center, and methodologically heterogeneous. Multicenter validation, standardized acquisition and segmentation, transparent reporting, and demonstration of added clinical value are required before these methods can be implemented in routine care.<\/jats:p>","DOI":"10.3390\/cancers18132129","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:50:37Z","timestamp":1782867037000},"page":"2129","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Central Role of Imaging in Renal Cell Carcinoma: A Comprehensive Review of Tumor Aggressiveness, Histology, and Radiomics"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0702-1267","authenticated-orcid":false,"given":"Andreu","family":"Ivars","sequence":"first","affiliation":[{"name":"Radiology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Pa\u00f1o","sequence":"additional","affiliation":[{"name":"Radiology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-6599","authenticated-orcid":false,"given":"Josep","family":"Puig","sequence":"additional","affiliation":[{"name":"Radiology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Fresno","sequence":"additional","affiliation":[{"name":"Radiology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-554X","authenticated-orcid":false,"given":"Leonardo","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Pathology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Sebastia","sequence":"additional","affiliation":[{"name":"Radiology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1381-6442","authenticated-orcid":false,"given":"Carlos","family":"Nicolau","sequence":"additional","affiliation":[{"name":"Radiology Department, Clinic Hospital, IDIBAPS, University of Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0140-6736(24)00917-6","article-title":"Renal Cell Carcinoma","volume":"404","author":"Young","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.eururo.2025.06.005","article-title":"Epidemiology of Renal Cancer: Incidence, Mortality, Survival, Genetic Predisposition, and Risk Factors","volume":"88","author":"Larcher","year":"2025","journal-title":"Eur. 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