Purpose: Clear cell tubulopapillary renal cell carcinoma (CCTPRCC) is a recently described, low-grade subtype of renal cancer. We determined if imaging features could be used to distinguish early-stage CCTPRCC from stage-matched clear cell RCC (ccRCC) and papillary RCC (pRCC). Methods: This IRB-approved retrospective study included 54 stage T1a patients with pathologically confirmed CCTPRCC ( n = 18), ccRCC ( n = 18), and pRCC ( n = 18). CT ( n = 48) and MRI ( n = 27) exams were reviewed and imaging features compared. Continuous variables were evaluated using ANOVA and Tukey's multiple comparison tests. Categorical variables were compared using Chi-square test or Fisher's exact test. Results: Compared to pRCC, CCTPRCC had a lower mean attenuation value on unenhanced CT ( p < 0.017), was more often hyperintense on T2-weighted images ( p < 0.0001), showed an ill-defined margin ( p = 0.003), and demonstrated nonenhancing areas ( p = 0.0003). The presence of all three of these statistically significant features [hypoattenuation (unenhanced attenuation ≤25 HU), ill-defined margin, nonenhancing areas] yielded an area under the receiver operator curve (ROC) of 0.92 (95% CI 0.83-0.99) for differentiating CCTPRCC from pRCC. There were no significant differences in the imaging features of CCTPRCC and ccRCC. Conclusions: Early-stage clear cell tubulopapillary renal cell carcinoma can be distinguished from papillary RCC based on low attenuation on unenhanced CT, high intensity on T2-weighted images, an ill-defined margin, and presence of nonenhancing areas, but cannot be distinguished from clear cell RCC. [ABSTRACT FROM AUTHOR]