Top

Published in:

Open Access 01-12-2018 | Research article

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

Authors: Lisa C. Adams, Bernhard Ralla, Yi-Na Y. Bender, Keno Bressem, Bernd Hamm, Jonas Busch, Florian Fuller, Marcus R. Makowski

Published in: Cancer Imaging | Issue 1/2018

Abstract

Background

Renal cell carcinoma (RCC) are accompanied by inferior vena cava (IVC) thrombus in up to 10% of the cases, with surgical resection remaining the only curative option. In case of IVC wall invasion, the operative procedure is more challenging and may even require IVC resection. This study aims to determine the diagnostic performance of contrast-enhanced magnetic resonance imaging (MRI) for the assessment of wall invasion by IVC thrombus in patients with RCC, validated with intraoperative findings.

Methods

Data were collected on 81 patients with RCC and IVC thrombus, who received a radical nephrectomy and vena cava thrombectomy between February 2008 and November 2017. Forty eight patients met the inclusion criteria. Sensitivity and specificity as well as the positive and negative predictive values were calculated for preoperative MRI, based on the assessments of the two readers for visual wall invasion. Furthermore, a logistic regression model was used to determine if there was an association between intraoperative wall adherence and IVC diameter.

Results

Complete occlusion of the IVC lumen or vessel breach could reliably assess IVC wall invasion with a sensitivity of 92.3% (95%-CI: 0.75–0.99) and a specificity of 86.4% (95%-CI: 0.65–0.97) (Fisher-test: p-value< 0.001). The positive predictive value (PPV) was 88.9% (95%-CI: 0.71–0.98) and the negative predictive value reached 90.5% (95%-CI: 0.70–0.99). There was an excellent interobserver agreement for determining IVC wall invasion with a kappa coefficient of 0.90 (95%CI: 0.79–1.00).

Conclusions

The present study indicates that standard preoperative MR imaging can be used to reliably assess IVC wall invasion, evaluating morphologic features such as the complete occlusion of the IVC lumen or vessel breach. Increases in IVC diameter are associated with a higher probability of IVC wall invasion.

Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67:913–24.CrossRefPubMed

Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94:33–41.CrossRefPubMed

Wagner B, Patard JJ, Mejean A, Bensalah K, Verhoest G, Zigeuner R, Ficarra V, Tostain J, Mulders P, Chautard D, et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol. 2009;55:452–9.CrossRefPubMed

Hatcher PA, Anderson EE, Paulson DF, Carson CC, Robertson JE. Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol. 1991;145:20–3. discussion 23-24.

Rodriguez Faba O, Linares E, Tilki D, Capitanio U, Evans CP, Montorsi F, Martinez-Salamanca JI, Libertino J, Gontero P, Palou J. Impact of Microscopic Wall invasion of the renal vein or inferior vena cava on Cancer-specific survival in patients with renal cell carcinoma and tumor Thrombus: a multi-institutional analysis from the international renal cell carcinoma-venous Thrombus consortium. Eur Urol Focus. 2017. https://doi.org/10.1016/j.euf.2017.01.009.

Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM. Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology. 2007;69:1054–8.CrossRefPubMed

Roubidoux MA, Dunnick NR, Sostman HD, Leder RA. Renal carcinoma: detection of venous extension with gradient-echo MR imaging. Radiology. 1992;182:269–72.CrossRefPubMed

Manassero F, Mogorovich A, Di Paola G, Valent F, Perrone V, Signori S, Boggi U, Selli C. Renal cell carcinoma with caval involvement: contemporary strategies of surgical treatment. Urol Oncol. 2011;29:745–50.CrossRefPubMed

Aslam Sohaib SA, Teh J, Nargund VH, Lumley JS, Hendry WF, Reznek RH. Assessment of tumor invasion of the vena caval wall in renal cell carcinoma cases by magnetic resonance imaging. J Urol. 2002;167:1271–5.CrossRefPubMed

10.

Zini L, Destrieux-Garnier L, Leroy X, Villers A, Haulon S, Lemaitre L, Koussa M. Renal vein ostium wall invasion of renal cell carcinoma with an inferior vena cava tumor thrombus: prediction by renal and vena caval vein diameters and prognostic significance. J Urol. 2008;179:450–4. discussion 454.

11.

Kandpal H, Sharma R, Gamangatti S, Srivastava DN, Vashisht S. Imaging the inferior vena cava: a road less traveled. Radiographics. 2008;28:669–89.CrossRefPubMed

12.

Oto A, Herts BR, Remer EM, Novick AC. Inferior vena cava tumor thrombus in renal cell carcinoma: staging by MR imaging and impact on surgical treatment. AJR Am J Roentgenol. 1998;171:1619–24.CrossRefPubMed

13.

Myneni L, Hricak H, Carroll PR. Magnetic resonance imaging of renal carcinoma with extension into the vena cava: staging accuracy and recent advances. Br J Urol. 1991;68:571–8.CrossRefPubMed

14.

Psutka SP, Boorjian SA, Thompson RH, Schmit GD, Schmitz JJ, Bower TC, Stewart SB, Lohse CM, Cheville JC, Leibovich BC. Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus. BJU Int. 2015;116:388–96.CrossRefPubMed

15.

Psutka SP, Leibovich BC. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma. Ther Adv Urol. 2015;7:216–29.CrossRefPubMedPubMedCentral

16.

Hatakeyama S, Yoneyama T, Hamano I, Murasawa H, Narita T, Oikawa M, Hagiwara K, Noro D, Tanaka T, Tanaka Y, et al. Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center. BMC Urol. 2013;13:47.CrossRefPubMedPubMedCentral

17.

Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59:390–5.CrossRefPubMed

18.

Chen X, Li S, Xu Z, Wang K, Fu D, Liu Q, Wang X, Wu B. Clinical and oncological outcomes in Chinese patients with renal cell carcinoma and venous tumor thrombus extension: single-center experience. World J Surg Oncol. 2015;13:14.CrossRefPubMedPubMedCentral

19.

Cho MC, Kim JK, Moon KC, Kim HH, Kwak C. Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system. Int Braz J Urol. 2013;39:353–63.CrossRefPubMed

20.

Whitson JM, Reese AC, Meng MV. Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus. Urol Oncol. 2013;31:259–63.CrossRefPubMed

21.

Laissy JP, Menegazzo D, Debray MP, Toublanc M, Ravery V, Dumont E, Schouman-Claeys E. Renal carcinoma: diagnosis of venous invasion with Gd-enhanced MR venography. Eur Radiol. 2000;10:1138–43.CrossRefPubMed

22.

Vergho DC, Loeser A, Kocot A, Spahn M, Riedmiller H. Tumor thrombus of inferior vena cava in patients with renal cell carcinoma - clinical and oncological outcome of 50 patients after surgery. BMC Res Notes. 2012;5:5.CrossRefPubMed

23.

Gohji K, Yamashita C, Ueno K, Shimogaki H, Kamidono S. Preoperative computerized tomography detection of extensive invasion of the inferior vena cava by renal cell carcinoma: possible indication for resection with partial cardiopulmonary bypass and patch grafting. J Urol. 1994;152:1993–6. discussion 1997.

24.

Edge SB, Compton CC. The American joint committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed

25.

Hallscheidt PJ, Fink C, Haferkamp A, Bock M, Luburic A, Zuna I, Noeldge G, Kauffmann G. Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: prospective study with histopathological correlation. J Comput Assist Tomogr. 2005;29:64–8.CrossRefPubMed

26.

Guo HF, Song Y, Na YQ. Value of abdominal ultrasound scan, CT and MRI for diagnosing inferior vena cava tumour thrombus in renal cell carcinoma. Chin Med J. 2009;122:2299–302.PubMed

27.

Gupta NP, Ansari MS, Khaitan A, Sivaramakrishna MS, Hemal AK, Dogra PN, Seth A. Impact of imaging and thrombus level in management of renal cell carcinoma extending to veins. Urol Int. 2004;72:129–34.CrossRefPubMed

28.

Cuevas C, Raske M, Bush WH, Takayama T, Maki JH, Kolokythas O, Meshberg E. Imaging primary and secondary tumor thrombus of the inferior vena cava: multi-detector computed tomography and magnetic resonance imaging. Curr Probl Diagn Radiol. 2006;35:90–101.CrossRefPubMed

29.

Lawrentschuk N, Gani J, Riordan R, Esler S, Bolton DM. Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review. BJU Int. 2005;96:291–5.CrossRefPubMed

30.

Takeuchi M, Matsuzaki K, Harada M. Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy. Acta Radiol. 2016;57:1277–84.CrossRefPubMed

31.

Huang YT, Chang CB, Yeh CJ, Lin G, Huang HJ, Wang CC, Lu KY, Ng KK, Yen TC, Lai CH. Diagnostic accuracy of 3.0T diffusion-weighted MRI for patients with uterine carcinosarcoma: assessment of tumor extent and lymphatic metastasis. J Magn Reson Imaging. 2018. https://doi.org/10.1002/jmri.25981.

32.

Caivano R, Rabasco P, Lotumolo A, D’Antuono F, Zandolino A, Villonio A, Macarini L, Guglielmi G, Salvatore M, Cammarota A. Gastric cancer: the role of diffusion weighted imaging in the preoperative staging. Cancer Investig. 2014;32:184–90.CrossRef

33.

Delli Pizzi A, Cianci R, Genovesi D, Esposito G, Timpani M, Tavoletta A, Pulsone P, Basilico R, Gabrielli D, Rosa C, et al. Performance of diffusion-weighted magnetic resonance imaging at 3.0T for early assessment of tumor response in locally advanced rectal cancer treated with preoperative chemoradiation therapy. Abdom Radiol. 2018. https://doi.org/10.1007/s00261-018-1457-8.

34.

Wang F, Wu LM, Hua XL, Zhao ZZ, Chen XX, Xu JR. Intravoxel incoherent motion diffusion-weighted imaging in assessing bladder cancer invasiveness and cell proliferation. J Magn Reson Imaging. 2018;47:1054–60.CrossRefPubMed

35.

Ota T, Hori M, Onishi H, Sakane M, Tsuboyama T, Tatsumi M, Nakamoto A, Kimura T, Narumi Y, Tomiyama N. Preoperative staging of endometrial cancer using reduced field-of-view diffusion-weighted imaging: a preliminary study. Eur Radiol. 2017;27:5225–35.CrossRefPubMed

36.

Ogura K, Maekawa S, Okubo K, Aoki Y, Okada T, Oda K, Watanabe Y, Tsukayama C, Arai Y. Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. Urology. 2001;57:721–6.CrossRefPubMed

37.

Luzurier A, Jouve De Guibert PH, Allera A, Feldman SF, Conort P, Simon JM, Mozer P, Comperat E, Boudghene F, Servois V, et al. Dynamic contrast-enhanced imaging in localizing local recurrence of prostate cancer after radiotherapy: limited added value for readers of varying level of experience. J Magn Reson Imaging. 2018. https://doi.org/10.1002/jmri.25991.

38.

Mazaheri Y, Akin O, Hricak H. Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: a review of current methods and applications. World J Radiol. 2017;9:416–25.CrossRefPubMedPubMedCentral

Title: Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI
Authors: Lisa C. Adams
Bernhard Ralla
Yi-Na Y. Bender
Keno Bressem
Bernd Hamm
Jonas Busch
Florian Fuller
Marcus R. Makowski
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Cancer Imaging / Issue 1/2018
Electronic ISSN: 1470-7330
DOI: https://doi.org/10.1186/s40644-018-0150-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Image quality of arterial phase and parenchymal blood volume (PBV) maps derived from C-arm computed tomography in the evaluation of transarterial chemoembolization

Evaluation of pancreatic tumor development in KPC mice using multi-parametric MRI

11C-acetate PET/MRI in bladder cancer staging and treatment response evaluation to neoadjuvant chemotherapy: a prospective multicenter study (ACEBIB trial)

“Sentinel lymph node imaging with sequential SPECT/CT lymphoscintigraphy before and after neoadjuvant chemoradiotherapy in patients with cancer of the oesophagus or gastro-oesophageal junction – a pilot study”

Risk of renal events following intravenous iodinated contrast material administration among inpatients admitted with cancer a retrospective hospital claims analysis

Diffusion-weighted imaging of rectal cancer on repeatability and cancer characterization: an effect of b-value distribution study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer