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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 673-677. doi: 10.19723/j.issn.1671-167X.2019.04.013

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Evaluating inferior vena cava wall invasion in renal cell carcinoma tumor thrombus with MRI

Jing-yun WU1,Yue MI2,Shui LIU1,Lin YAO2,Qi TANG2,Zhi-song HE2,Xiao-ying WANG1,△()   

  1. 1.Department of Radiology, Peking University First Hospital, Beijing 100034, China
    2.Department of Urology, Peking University First Hospital, Beijing 100034, China
  • Received:2019-04-16 Online:2019-08-18 Published:2019-09-03
  • Contact: Xiao-ying WANG E-mail:cjr.wangxiaoying@vip.163.com

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Abstract:

Objective: To evaluate the diagnostic performance of MRI for the assessment of inferior vena cava (IVC) wall invasion by IVC thrombus in patients with renal cell carcinoma (RCC).Methods: We retrospectively collected patients who underwent radical nephrectomy and thrombectomy for RCC between 2010 and 2018 at Peking University First Hospital. All the patients underwent imaging on a 1.5 Tesla or 3.0 Tesla MRI scanner. Fifty-six patients met the inclusion criteria. Preoperative imaging was reviewed by two radiologists blinded to details of the patient’s surgical procedure and histopathology. Two radiologists measured the maximum anterior-posterior diameter and coronal diameters of the IVC and renal vein, and the craniocaudal extent of tumor thrombus, and evaluated the MRI features of IVC thrombus, including occlusion of the IVC lumen,the margin of the tumor thrombus (smooth vs. irregular), contact of the IVC thrombus and IVC wall, and altered signal of the IVC wall. Univariable and multivariable associations of clinical and radiographic features with IVC wall invasion were evaluated by Logistic regression.Results: Of the 56 patients [male: 43, female: 13, mean age: (55.64±0.43) years], 17 (30.36%) were detected with IVC wall invasion, and most were clear cell carcinoma. Tumor thrombus with IVC wall invasion showed an increase in length of IVC thrombus [(7.91±3.59) cm vs. (5.94±3.57) cm, P=0.049], and more features of complete occlusion of the IVC lumen (P=0.002),irregular margin of the IVC thrombs (P=0.005), contact of the IVC thrombus and IVC wall (P=0.001), and altered signal of the low-intensity vessel wall (P<0.001), with a sensitivity of 94.12% and a specificity of 79.49%.Conclusion: The present study indicates that MRI could be a means of evaluating RCC with IVC wall invasion, and the combination of tumor thrombus length and subjective impression of IVC wall invasion achieved a high sensitivity and specificity for diagnosis.

Key words: Carcinoma, renal cell, Thrombus, Vena cava, inferior, Magnetic resonance imaging

CLC Number: 

  • R737.11

Table 1

Clinical characteristics of the study population (IVC wall invasion group vs. no IVC wall invasion group)"

Items Invasion (n=17) No invasion (n=39) Statistics P
Age/years, x?±s 57.410±10.038 54.870±12.612 0.535 0.593
Gender, n (%) 1.759 0.180
Male 15 (88.235) 28 (71.795)
Female 2 (11.765) 11 (28.205)
Pathology type, n (%) 8.758 0.271
Clear cell carcinoma 13 (76.471) 30 (76.923)
Papillary carcinoma 2 (11.765) 6 (15.385)
Chromophobe cell carcinoma 0 2 (5.128)
Clear cell carcinoma mixed with papillary carcinoma 0 1 (2.564)
Clear cell carcinoma mixed with chromophobe cell carcinoma 1 (5.882) 0
Collecting duct carcinoma 1 (5.882) 0
Thrombus level, n (%) 3.893 0.273
Ⅰ 1 (5.882) 6 (15.385)
Ⅱ 13 (76.471) 31 (79.487)
Ⅲ 2 (11.765) 2 (5.128)
Ⅳ 1 (5.882) 0

Table 2

MRI features of the study population (IVC wall invasion group vs. no IVC wall invasion group)"

Items Invasion (n=17) No invasion (n=39) Statistics P OR 95%CI
Contact of the IVC thrombus and IVC wall, n (%) 11.793 0.001 12.000 2.398-60.050
No contact 2 (11.765) 24 (61.538)
Contact 15 (88.235) 15 (38.462)
Occlusion of the IVC lumen, n (%) 9.636 0.002 9.706 1.949-48.335
Filling 15 (88.235) 17 (43.590)
No filling 2 (11.765) 22 (56.410)
Margin of the thrombus, n (%) 7.806 0.005 5.804 1.585-21.245
Smooth 4 (23.529) 25 (64.103)
Irregular 13 (76.471) 14 (35.897)
Altered signal of the IVC wall, n (%) 24.521 7.349×10-7 34.286 6.346-185.237
Altered 15 (88.235) 7 (17.949)
No altered 2 (11.765) 32 (82.051)
Length of IVC thrombus/cm 7.906±3.592 5.939±3.570 1.961 0.049
Maximal anterior-posterior diameter of renal vein/cm 1.877±0.549 1.744±0.520 0.957 0.339
Maximal superior-inferior diameter of renal vein/cm 1.953±0.532 1.926±0.559 -0.080 0.936
Maximal anterior-posterior diameter of IVC/cm 3.288±0.704 2.672±1.300 1.837 0.066
Maximal coronal diameter of IVC/cm 3.041±0.780 2.672±1.300 1.641 0.101

Figure 1

ROC curve based on the binary Logistic regression model"

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