Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI

Figures

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  Fig. 1. Images in a 55-year old man with a clear cell renal cell carcinoma (RCC) and an inferior vena cava (IVC) tumor thrombus with wall invasion. The RCC extends from the right kidney into the suprahepatic IVC. a axial fat-saturated T2-weighted image. b T1-weighted contrast-enhanced 3D GRE (VIBE) image (arterial phase) and (c), coronal T2-weighted HASTE image for anatomic reference. Note that the thrombus completely obstructs the lumen of the IVC and shows direct contact with the vessel wall (a, c). The contrast-enhanced image (b) demonstrates a heterogeneous enhancement of the tumor thrombus, and contact to, but no breach of the vessel wall, which makes IVC wall invasion likely. During extended nephrectomy, this thrombus was partly adherent the IVC and after extraction of the IVC thrombus, continuous suturing became necessary. VIBE = Volumetric interpolated breath-hold examination

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  Fig. 2. Images in a 69-year old woman with a clear cell renal cell carcinoma (RCC) and an inferior vena cava (IVC) tumor thrombus with wall invasion. The RCC extends from the right kidney into the IVC and extends into the right atrium. a axial fat-saturated T2-weighted image. b T1-weighted contrast-enhanced 3D GRE (VIBE) image contrast enhanced 3D GRE image (arterial phase) and (c), coronal T2-weighted HASTE image for anatomic reference. Note that the thrombus completely obstructs the lumen of the IVC, but also seems to breach the vessel wall (a, c). The contrast-enhanced image (b) demonstrates a heterogeneous enhancement of the tumor thrombus and a clear breach of the vessel wall (gray arrowhead), which is highly suggestive of IVC wall invasion. During extended nephrectomy, this thrombus showed strong adherence to the IVC wall and during extraction, circumferential cavectomy with vascular reconstruction became necessary. VIBE = Volumetric interpolated breath-hold examination

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  Fig. 3. Images in a 79-year old woman with a clear cell renal cell carcinoma (RCC) and bland inferior vena cava (IVC) thrombus without wall invasion. The RCC extends from the right kidney into the infrahepatic IVC. a axial T2-weighted HASTE image. b T1-weighted contrast-enhanced 3D GRE (VIBE) image and (c), the coronal T2-weighted HASTE image for anatomic reference. Note that the thrombus is floating in the IVC and that there is no complete obstruction of the caval lumen (a, c). The contrast-enhanced image (b) demonstrates that there is no enhancement of the tumor thrombus, contact to or breach of the vessel wall, so that IVC wall invasion appears unlikely. During extended nephrectomy, this thrombus could be easily removed from the IVC without necessitating segmental resection. HASTE = Half-Fourier-acquired singe-shot turbo spin echo, VIBE = Volumetric interpolated breath-hold examination