Why the study?
Appropriate clinical and surgical management of RCC with tumor thrombus requires radiologists to accurately evaluate and report critical imaging features.
Provides a radiologist's guide to evaluating and reporting renal cell carcinoma with tumor thrombus using CT and MRI to guide multidisciplinary management.
Renal cell carcinomas (RCCs) with tumor thrombus (TT) are a subset of kidney cancers characterized by extension of tumor into the venous system. In such cases, TT can extend into the main renal vein, followed by the inferior vena cava (IVC), and can ascend to the right atrium. CT and MRI are both well suited for the evaluation of RCC with TT (hereafter, RCC-TT), although MRI is slightly more accurate for determining thrombus extent. To ensure appropriate clinical and surgical management of patients with RCC-TT, radiologists should report TT level (ideally using the Mayo Clinic classification system), describe relevant vascular variants that might be present, assess the extent of neovascularization and collateral pathways resulting from the thrombus, and mention any superimposed bland thrombus and/or IVC wall invasion. This Pictorial Essay explains the importance of each of these reporting elements through case examples while encouraging clear communication and close collaboration with the multidisciplinary team.
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