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The feasibility of contrast-enhanced CT to identify the adhesive renal venous tumor thrombus of renal cell carcinoma

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To identify adhesive renal venous tumor thrombus (RVTT) of renal cell carcinoma (RCC) by contrast-enhancement CT (CECT).

Materials and methods

Our retrospective study included 53 patients who underwent preoperative CECT and pathologically confirmed RCC combined with RVTT. They were divided into two groups based on the intra-operative findings of RVTT adhesion to the venous wall, with 26 cases in the adhesive RVTT group (ARVTT) and 27 cases in the non-adhesive group (NRVTT). The location, maximum diameter (MD) and CT values of tumors, the maximum length (ML) and width (MW) of RVTT, and length of inferior vena cava tumor thrombus were compared between the two groups. The presence of renal venous wall involvement, renal venous wall inflammation, and enlarged retroperitoneal lymph node was compared between the two groups. A receiver operating characteristic curve was used to analyze the diagnostic performance.

Results

The MD of RCC and the ML and MW of the RVTT were all larger in the ARVTT group than in the NRVTT group (p = 0.042, p < 0.001, and p = 0.002). The proportion of renal vein wall involvement and renal vein wall inflammation were higher in the ARVTT group than in NRVTT groups (both p < 0.001). The multivariable model including ML and vascular wall inflammation to predict ARVTT could achieve the best diagnostic performance with the area under the curve, sensitivity, specificity, and accuracy of 0.91, 88.5%, 96.3%, and 92.5%, respectively.

Conclusion

The multivariable model acquired by CECT images could be used to predict RVTT adhesion.

Clinical relevance statement

For RCC patients with tumor thrombus, contrast-enhanced CT could noninvasively predict the adhesion of tumor thrombus, thus predicting the difficulty of surgery and contributing to the selection of an appropriate treatment plan.

Key Points

• The length and width of the tumor thrombus could be used to predict its adhesion to the vessel wall.

• Adhesion of the tumor thrombus can be reflected by inflammation of the renal vein wall.

• The multivariable model from CECT can well predict whether the tumor thrombus adhered to the vein wall.

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Abbreviations

ARVTT:

Adhesive renal venous tumor thrombus

AUC:

Area under the curve

CECT:

Contrast-enhancement computed tomography

IVC:

Inferior vena cava

L-VCT:

Length of the tumor thrombus in the inferior vena cava

MD:

Maximum diameter

ML:

Maximum length

MW:

Maximum width

NRVTT:

Non-adhesive renal venous tumor thrombus

RCC:

Renal cell carcinoma

ROC:

Receiver operating characteristic

RVTT:

Renal venous tumor thrombus

VCT:

Tumor thrombus in the inferior vena cava

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Funding

This work was supported by the National High Level Hospital Clinical Research Funding (grant no.2022-PUMCH-A-033), the CAMS Innovation Fund for Medical Sciences (grant no.2022-I2M-C&T-B-019), the National High Level Hospital Clinical Research Funding (grant no.2022-PUMCH-B-069), the National High Level Hospital Clinical Research Funding (grant no.2022-PUMCH-A-035), the National Natural Science Foundation of China (grant no.81901742), the National Natural Science Foundation of China (grant no. 91859119), and the 2021 Key clinical Specialty Program of Beijing, Beijing Municipal Key Clinical.

Author information

Author notes

  1. Zhengyu Jin and Hao Sun are co-corresponding authors and have contributed equally to this work.

  2. Xiaoxiao Zhang and Jincai Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China

    Xiaoxiao Zhang, Gumuyang Zhang, Lili Xu, Xin Bai, Jiahui Zhang, Li Chen, Qianyu Peng, Zhengyu Jin & Hao Sun

  2. Department of Radiology, Linyi Central Hospital, Linyi, Shandong Province, China

    Jincai Zhang

  3. National Center for Quality Control of Radiology, Beijing, 100730, China

    Zhengyu Jin & Hao Sun

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  1. Xiaoxiao Zhang
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Corresponding authors

Correspondence to Zhengyu Jin or Hao Sun.

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The scientific guarantor of this publication is Hao Sun.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

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• performed at one institution

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Zhang, X., Zhang, J., Zhang, G. et al. The feasibility of contrast-enhanced CT to identify the adhesive renal venous tumor thrombus of renal cell carcinoma. Eur Radiol 33, 7429–7437 (2023). https://doi.org/10.1007/s00330-023-09776-w

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  • DOI: https://doi.org/10.1007/s00330-023-09776-w

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