PURPOSE OF REVIEW: The increasing use of ultrasound and computerized tomography has led to over 50% of renal cell carcinomas being incidentally detected. With an increasing number of small and asymptomatic tumors being identified it is particularly important for an accurate diagnosis to be reached via available imaging modalities to permit selection of patients for surgical treatment. The identification of patients suitable for management via nephron-sparing surgery is a key issue. RECENT FINDINGS: Advances in imaging have focused on the ability to distinguish malignant from nonmalignant tumors. Advanced assessments have aimed to identify the cancer subtype preoperatively in order to limit the requirement for surgery in carcinomas with low metastatic potential. Improved staging of renal tumors with magnetic resonance imaging and positron emission tomography has allowed more accurate preoperative assessment and planning of treatment for both organ-confined and extensive renal tumors. Radioimmunoscintigraphy and radioimmunotherapy also offer potential for therapeutic intervention at an antigen-directed level. SUMMARY: More accurate matching of therapeutic options to newly diagnosed renal carcinomas is now possible with contemporary imaging techniques in order to limit morbidity of surgical treatment. The potential for urologists to progress to treatment of renal malignancies via advanced radiographic techniques is fast approaching.