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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 678-683. doi: 10.19723/j.issn.1671-167X.2019.04.014

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Comparison of various imaging in the diagnosis of renal cell carcinoma with inferior vena cava tumor thrombus combined with bland thrombus

Li-wei LI1,Zhuo LIU2,Guo-liang WANG2,Hua ZHANG3,Wen CHEN1,Jing MA1,Li ZHANG1,Wei HE4,Lu-lin MA2,△(),Shu-min WANG1,△()   

  1. 1. Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
    4. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-03-18 Online:2019-08-18 Published:2019-09-03
  • Contact: Lu-lin MA,Shu-min WANG E-mail:malulin@medmail.com.cn;shuminwang2014@163.com
  • Supported by:
    Supported by National Key Research and Development Program of China(2016YFC0104700)

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Abstract:

Objective: To analyse the clinical and imaging data of patients with renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT), and to assess the diagnostic efficacy of ultrasound, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) in the diagnosis of RCC with IVCTT combined with bland thrombus was assessed.Methods: We retrospectively analyzed the clinical and imaging data of 56 RCC patients with IVCTT who underwent radical nephrectomy and IVC thrombectomy between January 2014 and July 2018 in Department of Urology, Peking University Third Hospital. All the patients underwent US, enhanced CT and enhanced MRI preoperatively, and all the cases were confirmed with RCC with IVCTT by histological evaluation.Results: The criteria of RCC with IVCTT combined with bland thrombus was confirmed by intraoperative observation and postoperative pathology. The 56 patients were divided into bland thrombus group (n=18) and non bland thrombus group (n=38). Compared the two groups, it was found that the length of IVCTT was longer [(10.50 ± 5.55) cm vs.(6.66 ± 3.73) cm, P=0.014]; the ratio of diameter of IVCTT to maximum coronal diameter of IVC was closer to 1 [1.0 (0.7, 1.0) vs. 0.9 (0.2, 1.0), P=0.004]; the proportion of lower limb edema was higher [66.7(12/8)% vs.5.3%(2/36), P=0.005];the proportion of segmental resection or interrupt of IVC was higher [66.7%(12/18) vs.15.8%(6/38), P<0.001], with statistical significance. Compared with the three imaging methods of US, enhanced CT and MRI, the highest sensitivity was MRI (77.8%), the highest specificity was enhanced MRI and enhanced CT (97.4%), the highest accuracy was enhanced CT and enhanced MRI (83.9%), the highest positive predictive value was enhanced CT (90.9%) and the highest negative predictive value was enhanced MRI (89.2%).Conclusion: For the patients that RCC with IVCTT combined with bland thrombus, the length of IVCTT is longer, and the ratio of the diameter of IVCTT to the maximum corona diameter of IVC is closer to 1, and more likely to cause lower limb edema. Preoperative comprehensive evaluation of multiple images is needed to improve the accuracy of diagnosis.

Key words: Renal cell carcinoma, Inferior vena cava tumor thrombus, Bland thrombus, Imaging diagnosis, Ultrasound

CLC Number: 

  • R737.1

Figure 1

Summary of the study cohort and exclusion criteria"

Table 1

Comparison of clinical and radiographic features of the two groups"

Features n With bland thrombus
(n=18)		 Without bland thrombus
(n=38)		 P
Age/years, x?±s 56 57.37±8.78 60.21±13.33 0.369
Tumor diameter/cm, x?±s 56 8.82±3.75 9.04±3.34 0.263
IVCTT length/cm, x?±s 56 10.50±5.55 6.66±3.73 0.014*
IVCTT diameter/cm, x?±s 56 3.54±0.68 2.76±1.04 0.105
Maximum coronal IVC diameter/cm, x?±s 56 3.63±0.60 3.22±0.65 0.950
IVCTT diameter/maximum coronal IVC diameter, median (min, max) 56 1.0 (0.7,1.0) 0.9 (0.2,1.0) 0.004*
Gender, n (%) 56 0.773
Male 13 (72.2) 26 (68.4)
Female 5 (27.8) 12 (31.6)
Renal tumor side, n (%) 56 0.419
Right 11 (61) 28 (73.7)
Left 7 (38.9) 9 (23.7)
Blateral 0 (0) 1 (2.6)
Mayo classification, n (%) 56 0.203
Mayo Ⅰ 1 (5.6) 10 (26.3)
Mayo Ⅱ 6 (33.3) 14 (36.8)
Mayo Ⅲ 6 (33.3) 9 (23.7)
Mayo Ⅳ 5 (27.8) 5 (13.2)
Clinical symptoms, n (%) 56 0.005*
Lower limb edema 12 (66.7) 2 (5.3)
No lower limb edema 6 (33.3) 36 (97.4)
Pathological type, n (%) 56 0.447
ccRCC 16 (88.9) 30 (78.9)
pRCC 2 (11.1) 5 (13.2)
Other 0 (0) 3 (7.9)
Rhabdomyosis or sarcomatoid degeneration, n (%) 50 0.639
Yes 5 (27.8) 7 (21.9)
No 13 (72.2) 25 (78.1)
Nuclear grading, n (%) 53 0.829
Ⅱ 4 (23.6) 8 (22.9)
Ⅲ 9 (52.9) 16 (45.7)
Ⅳ 4 (23.5) 11 (31.4)
Segmental resection or interuption IVC, n (%) 58 <0.001*
Yes 12 (66.7) 6 (15.8)
No 6 (33.3) 32 (84.2)

Table 2

Clinical, pathological and imaging features of RCC with IVCTT combined with bland thrombus"

No. Gender Age/
years		 Renal
tumor
side		 Renal
tumor
diameter/cm		 Pathology Nuclear
grading		 IVCTT
length		 Mayo IVC
resection		 Bland thrombus
location		 length in
imaging/
cm		 Imaging diagnosis
US MRI CT
1 M 62 L 5.80 ccRCC 3 11.30 Ⅳ No Proximal - 0 0 0
2 M 67 R 3.60 ccRCC 2 16.40 Ⅳ Interruption Distal 12.94 0 1 1
3 M 53 R 7.70 ccRCC 4 18.60 Ⅱ Segmental Distal 8.50 0 1 0
4 M 53 R 6.40 ccRCC 4 20.00 Ⅳ Segmental Distal 2.00 0 1 1
5 F 62 R 10.30 ccRCC 3 20.00 Ⅲ Interruption Distal,contralateral 12.25 0 1 1
6 M 50 R 5.80 ccRCC 3 6.60 Ⅲ Segmental Distal,contralateral 2.70 1 1 1
7 M 71 R 7.20 ccRCC 3 15.50 Ⅲ Interruption Distal 8.80 0 1 1
8 M 45 R 10.30 ccRCC 2 10.00 Ⅳ Interruption Distal 2.13 0 1 1
9 M 58 L 13.00 ccRCC 3 6.25 Ⅱ Interruption Distal 3.30 0 1 0
10 M 47 L 15.50 pRCC 3 6.20 Ⅲ No Contralateral, - 0 0 0
11 M 58 L 14.50 ccRCC 4 5.00 Ⅲ Interruption Distal 1.30 0 1 1
12 F 69 L 10.90 ccRCC 3 14.30 Ⅳ No Distal 1.30 0 1 0
13 F 67 R 3.80 pRCC 3 9.40 Ⅱ Segmental Distal,contralateral 11.75 1 1 1
14 M 62 R 4.50 ccRCC 2 5.48 Ⅱ Interruption Distal, contralatera 7.84 0 1 1
15 M 48 R 12.00 ccRCC 4 6.90 Ⅲ Segmental Distal 2.00 0 1 0
16 F 41 R 6.80 ccRCC 3 3.20 Ⅱ No Contralateral - 0 0 0
17 M 57 L 13.30 ccRCC 4 5.80 Ⅱ No Contralateral - 0 0 0
18 F 63 R 7.30 ccRCC 2 8.00 Ⅰ No Distal 1.13 1 1 1

Table 3

Comparison of US, enhanced MRI and enhanced CT finding with surgical and pathologic diagnosis of RCC with IVCTT combined with bland thrombus"

Imaging diagnosis result Surgical pathologic diagnosis
With bland thrombus (n=18) Without bland thrombus (n=38)
US Positive 3 1
Negative 15 37
Enhanced MRI Positive 14 5
Negative 4 33
Enhanced CT Positive 10 1
Negative 8 37

Table 4

The diagnosis value of US, enhanced MRI and enhanced CT of RCC with IVCTT combined with bland thrombus /%"

Imaging diagnosis Sensitivity Specificity Accuracy Positive predictive value Negative predictive value
US 16.8 97.4* 71.4 75.0 71.2
Enhanced MRI 77.8* 86.8 83.9* 73.7 89.2*
Enhanced CT 55.7 97.4* 83.9* 90.9* 82.2
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