What is the clinical evidence from this study?

Study design: Observational. Population: Renal tumors with inferior vena cava tumor thrombus (IVCTT) (n=165). Intervention: Preoperative MRI-based diagnostic model vs. Intraoperative findings (reference standard). Primary outcome: Prediction of IVC wall invasion (AUC 0.88).

June 24, 2023Open Access

The value of enhanced multiparameteric MRI diagnostic model for preoperatively predicting surgical methods of inferior vena cava in patients with renal tumors and inferior vena cava tumor thrombus

XPXinlong PeiBeijing University of Agriculture MLMin LuSouth China Agricultural University ZLZhuo LiuQingdao University

Key Result

A preoperative MRI-based diagnostic model incorporating tumor thrombus morphology, primary tumor diagnosis, thrombus diameter, and bland thrombus length predicted IVC wall invasion with an AUC of 0.88.

Study Design

Type

Observational (n=165)

Blinding

Blinded to surgical and pathological data

Multicenter

Structured PICO

Does a preoperative enhanced multiparametric MRI-based diagnostic model accurately predict inferior vena cava wall invasion in patients with renal tumors and inferior vena cava tumor thrombus?

Population

165 patients (median age 59 years, 31.5% female) with renal tumors and inferior vena cava tumor thrombus who underwent radical resection and thrombectomy.

Exposure

Preoperative enhanced multiparametric MRI-based diagnostic model (incorporating IVCTT morphology, primary MRI diagnosis of renal tumor, maximum axis diameter of IVCTT, and length of bland thrombus)

Comparator

Intraoperative performance and resection scope of the IVC wall (reference standard)

Outcome

Prediction of IVC wall invasionsurrogate

A preoperative multiparametric MRI-based diagnostic model can reliably predict inferior vena cava wall invasion in patients with renal tumors, aiding in surgical planning.

Main Result

Effect estimate: AUC 0.88

Limitations

Retrospective study design with potential selection bias in tumor thrombus Mayo grade and tumor pathological type.
Reference criteria for venous wall invasion relied on intraoperative findings rather than pathological assessments.
Single-institution study requiring future multi-center validation.
Radiomics methods were not utilized.
The study population was predominantly male (68.5%), limiting generalizability to females.

Abstract

BACKGROUND: Inferior vena cava tumor thrombus (IVCTT) invading the IVC wall majorly affects the surgical method choice and prognosis in renal tumors. Enhanced multiparameteric MRI plays an important role in preoperative evaluation. In this work, an MRI-based diagnostic model for IVCTT was established so as to guide the preoperative decisions. METHODS: Preoperative MR images of 165 cases of renal tumors with IVCTT were retrospectively analyzed, and imaging indicators were analyzed, including IVCTT morphology and Mayo grade, IVCTT diameter measurements, bland thrombosis, primary MRI-based diagnosis of renal tumor, and involvement of contralateral renal vein. The indicators were analyzed based on intraoperative performance and resection scope of the IVC wall. Multivariate logistic regression analysis was used to establish the diagnostic model. RESULTS: The morphological classification of the IVCTT, primary MRI-based diagnosis of renal tumors, maximum transverse diameter of IVCTT, and length of the bland thrombus were the main indexes predicting IVC wall invasion. The MRI-based diagnostic model established according to these indexes had good diagnostic efficiency. The prediction probability of 0.61 was set as the cutoff value. The area under the curve of the test set was 0.88, sensitivity was 0.79, specificity was 0.85, and prediction accuracy was 0.79 under the optimal cutoff value. CONCLUSION: The preoperative MRI-based diagnostic model could reliably predict IVC wall invasion, which is helpful for better prediction of IVC-associated surgical operations.

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