A diagnostic model combining MRI tumor thrombus volume, entropy, and subjective overall impression achieved an AUC of 0.91 (95% CI, 0.77-1.0) for detecting inferior vena cava wall invasion.
Case-Control (n=24)
Blinded
Does MRI with quantitative and subjective analysis accurately detect inferior vena cava wall invasion in patients with renal cell carcinoma tumor thrombus?
Combining tumor thrombus volume, entropy, and subjective overall impression on MRI provides high diagnostic accuracy for detecting IVC wall invasion in renal cell carcinoma.
Estimación del efecto: AUC 0.91 (95% CI 0.77-1.0)
OBJECTIVE: The purpose of this study is to evaluate MRI in inferior vena cava (IVC) renal cell carcinoma (RCC) tumor thrombus for the diagnosis of caval wall invasion. MATERIALS AND METHODS: This retrospective case-control study evaluated 24 consecutive patients who underwent thrombectomy for RCC IVC tumor thrombus (11 45.8% with invasion) seen at preoperative MRI. A blinded radiologist segmented tumor thrombus on apparent diffusion coefficient (ADC) maps and T2-weighted images for texture analysis, measured the diameter of the renal vein and IVC at the level of the renal vein ostium, and measured the craniocaudal extent and volume of the tumor thrombus. Two blinded radiologists independently evaluated the margin of the tumor thrombus (smooth vs irregular), thinning or thickening and abnormal T2-weighted signal or enhancement of the IVC wall, and overall impression of invasion. Comparisons were performed using logistic regression models and chi-square with accuracy calculated using ROC. RESULTS: ; p = 0.003) than did thrombi without invasion. The ROC AUC ranged from 0.78 to 0.83. ADC and texture parameters were not significantly different between groups (p = 0.208-0.503); however, larger entropy in invasive tumor thrombus trended toward significance (p = 0.061). A model combining volume, entropy, and overall impression achieved an AUC of 0.91 (95% CI, 0.77-1.0). CONCLUSION: The combination of tumor thrombus volume with entropy and subjective overall impression of IVC wall invasion achieved the highest accuracy for diagnosis.
Alayed et al. (Thu,) conducted a case-control in Renal cell carcinoma with inferior vena cava tumor thrombus (n=24). Preoperative MRI (quantitative and subjective analysis) was evaluated on Diagnosis of caval wall invasion (AUC 0.91, 95% CI 0.77-1.0). A diagnostic model combining MRI tumor thrombus volume, entropy, and subjective overall impression achieved an AUC of 0.91 (95% CI, 0.77-1.0) for detecting inferior vena cava wall invasion.