The global incidence of adult renal cancer continues to increase, with little change in the predominant cell type, renal cell carcinoma. The rise in incidence is in part due to an increasing number of imaging studies of the abdomen and pelvis performed for a variety of reasons, and therefore, incidental diagnosis. The majority of cases are localized. This has a favorable prognostic impact, since cancer may be detected at an earlier stage. The various imaging modalities including ultrasound, CT, and MRI available for the detection, diagnosis, staging, and surveillance of adult renal cancer are discussed in this chapter. Future directions of imaging, including antibody-directed PET imaging, and functional imaging evaluation are also considered.