Abdominal Imaging

, Volume 32, Issue 4, pp 530–537 | Cite as

Venous spread of renal cell carcinoma: MDCT

  • Ranka Stern Padovan
  • Drazen Perkov
  • Ranko Smiljanic
  • Bozidar Oberman
  • Kristina Potocki
Article

Abstract

Background

The purpose of our study was to present multidetector computed tomography (MDCT) findings in venous spread of renal cell carcinoma (RCC), to determine the superior extent of tumor thrombus and to compare MDCT findings with surgical report.

Methods

The prospective MDCT study was performed on 31 patients diagnosed with RCC with venous spread (19 males and 12 females; age range 39–80 years; mean age 62.6 years). CT scans were obtained by MDCT scanner, in triphasic scanning protocol. All postprocessing techniques were performed by two independent radiologists, and the findings were reported in their consensus. MDCT diagnosis was compared with surgical and pathohistological findings.

Results

Tumor thrombus extension into renal vein only (T3b stage) was found in 13/31 (42%) patients. Involvement of infradiaphragmatic level of inferior vena cava (IVC) (T3c stage) was found in 14/31 (45%) patients and supradiaphragmatic level of IVC (T4b stage) in 4/31 (13%) patients. In 27/31 (87%) patients surgery was performed, while 4/31 (13%) could not undergo surgery. In comparison with surgical report, in 25/27 (93%) operated patients the upper extent of the tumor thrombus was correctly diagnosed by MDCT, and 2/27 (7%) patients were falsely diagnosed.

Conclusion

MDCT represents a fast, relatively inexpensive, and reliable diagnostic method for evaluating the venous spread of RCC as well as the level of its upper extent. Triphasic MDCT is often the only diagnostic method necessary for planning the surgical procedure. Surgery should be performed as soon as possible for MDCT findings to be valid.

Keywords

Renal cell carcinoma Multidetector computed tomography Staging Renal vein Inferior vena cava 

References

  1. 1.
    Kabala JE (2003) The kidneys and ureters. In: Sutton D, (eds). Textbook of radiology and imaging. London: Churchill Livingstone, pp 953Google Scholar
  2. 2.
    Hoehn W, Hermanek P (1983) Invasion of veins in renal cell carcinoma: frequency, correlation and prognosis. Eur Urol 9:276PubMedGoogle Scholar
  3. 3.
    Casanova GA, Zingg EJ (1991) Inferior vena caval tumor extension in renal cell carcinoma. Urol Int 47:216PubMedCrossRefGoogle Scholar
  4. 4.
    Hatcher PA, Anderson EE, Paulson DF, et al. (1991) Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol 145:20–24PubMedGoogle Scholar
  5. 5.
    Pagano F, Dal Bianco M, Artibani W, et al. (1992) Renal cell carcinoma with extension into the inferior vena cava: problems in diagnosis, staging and treatment. Eur Urol 22:200PubMedGoogle Scholar
  6. 6.
    Zisman A, Wieder JA, Pantuck AJ, et al. (2003) Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol 169:909–916PubMedCrossRefGoogle Scholar
  7. 7.
    Lang H, Lindner V, Saussine C, et al. (2000) Microscopic venous invasion: a prognostic factor in renal cell carcinoma. Eur Urol 38:600–605PubMedCrossRefGoogle Scholar
  8. 8.
    Bonisb SM (2006) Renal lymphatics, and lymphatic involvement in sinus vein invasive (pT3b) clear cell renal cell carcinoma: a study of 40 cases. Mod Pathol 19:746–753CrossRefGoogle Scholar
  9. 9.
    Kallman DA, King BF, Hattery RR, et al. (1992) Renal vein and inferior vena cava tumor thrombus in renal cell carcinoma: CT, US, MRI and venocavography. J Comput Assist Tomogr 16:240–247PubMedCrossRefGoogle Scholar
  10. 10.
    Staehler G, Brkovic D (2000) The role of radical surgery for renal cell carcinoma with extension into the vena cava. J Urol 163:1671–1675PubMedCrossRefGoogle Scholar
  11. 11.
    Russo P (2000) Renal cell carcinoma: presentation, staging and surgical treatment. Semin Oncol 27:160–176PubMedGoogle Scholar
  12. 12.
    Figlin RA (1999) Renal cell carcinoma: management of advanced disease. J Urol 161:381–386PubMedCrossRefGoogle Scholar
  13. 13.
    Sheth S, Scatarige JC, Horton KM, et al. (2001) Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector CT and three-dimensional CT. Radiographics 21:237–254Google Scholar
  14. 14.
    Repassy DL (1999) Prognostic index of renal carcinomas. Int Urol Nephrol 31:135–140PubMedCrossRefGoogle Scholar
  15. 15.
    Moinzadeh A, Libertino JA (2004) Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all t3b the same? J Urol 171:598–601Google Scholar
  16. 16.
    Johnson CD, Dunnick NR, Cohan RH, et al. (1987) Renal adenocarcinoma: CT staging of 100 tumors. AJR 148:59–63PubMedGoogle Scholar
  17. 17.
    Reznek RH (1996) Imaging in the staging of renal cell carcinoma. Eur Radiol 6:120–128PubMedGoogle Scholar
  18. 18.
    Walter C, Kruessell M, Gindele A, et al. (2003) Imaging of renal lesions: evaluation of fast MRI and helical CT. Br J Radiol 76:696–703PubMedCrossRefGoogle Scholar
  19. 19.
    Hu H, He HD, Foley WD, et al. (2000) Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 215:55–62PubMedGoogle Scholar
  20. 20.
    Guinan P, Sobin LH, Algaba F, et al. (1997) TNM staging of renal cell carcinoma: workgroup no. 3 Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 80:992–993PubMedCrossRefGoogle Scholar
  21. 21.
    Glazer AA, Novick AC (1996) Long-term follow up after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol 155:448–450PubMedCrossRefGoogle Scholar
  22. 22.
    Ficarra V, Righetti R, Dàmico A, et al. (2001) Renal vein and vena cava involvement does not affect prognosis in patients with renal cell carcinoma. Oncology 61:10–15PubMedCrossRefGoogle Scholar
  23. 23.
    Bissada NK, Yakout HH, Babanouri A, et al. (2003) Long-term experience with management of renal cell carcinoma involving the inferior vena cava. Urology 61:89–92PubMedCrossRefGoogle Scholar
  24. 24.
    Skinner DG, Pritchett TR, Lieskovsky G, et al. (1989) Vena caval involvement by renal cell carcinoma. Ann Surg 210:387–394PubMedCrossRefGoogle Scholar
  25. 25.
    Montie JE, El Ammar R, Pontes JE, et al. (1991) Renal cell carcinoma with inferior vena cava tumor thrombi. Surg Gynecol Obstet 173:107–115PubMedGoogle Scholar
  26. 26.
    Neves RJ, Zincke H (1987) Surgical treatment of renal cancer with vena cava extension. Br J Urol 59:390–395PubMedGoogle Scholar
  27. 27.
    Ornstein DK, Arcangeli CG, Andriole GL (1997) Renal masses: urologic management. Magn Reson Imaging Clin N Am 5(1):1–12PubMedGoogle Scholar
  28. 28.
    Nesbitt JC, Soltero ER, Dinney CPN, et al. (1997) Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann Thorac Surg 63:1592–1600PubMedCrossRefGoogle Scholar
  29. 29.
    Schimmer C, Hillig F, Riedmiller H, et al. (2004) Surgical treatment of renal cell carcinoma with intravascular extension. Interact Cardiovasc Thorac Surg 3:395–397PubMedCrossRefGoogle Scholar
  30. 30.
    Swierzewski DJ, Swierzewski JA (1994) Radical nephrectomy in patients with renal cell carcinoma with venous, vena caval, and atrial extension. Am J Surg 168:205–209PubMedCrossRefGoogle Scholar
  31. 31.
    Klein EA, Kaye MC, Novick AC (1991) Management of renal cell carcinoma with vena caval thrombi via cardiopulmonary bypass and deep hypothermic circulatory arrest. Urol Oncol 18:445–447Google Scholar
  32. 32.
    Novick AC, Kaye MC, Cosgrove DM, et al. (1990) Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg 212:472–477PubMedCrossRefGoogle Scholar
  33. 33.
    Hallscheidt P, Schoenberg S, Schenk JP, et al. (2002) Multi-slice CT in the planning of nephron-sparing interventions for renal cell carcinoma: Prospective study correlated with histopathology. Rofo Fortschr Röntgenstr 174:898–903CrossRefGoogle Scholar
  34. 34.
    Wunderlicht H, Reichelt O, Shummann S, et al. (1998) Nephron sparing surgery for renal cell carcinoma 4 cm or less in diameter: indicated or under treatment? J Urol 159:1465–1469CrossRefGoogle Scholar
  35. 35.
    Moch H, Gasser T, Amin M, et al. (2000) Prognostic utility of recently recommended histologic classification and revised TNM staging system of renal cell carcinoma. Cancer 89:604–614PubMedCrossRefGoogle Scholar
  36. 36.
    Lang EK (1984) Comparison of dynamic and conventional computed tomography, angiography, and ultrasonography in the staging of renal cell carcinoma. Cancer 54:2205–2214PubMedCrossRefGoogle Scholar
  37. 37.
    Hietala SO, Ekelund L, Ljungberg B (1988) Venous invasion in renal cell carcinoma. A correlative clinical and radiologic study. Urol Radiol 9:210–216PubMedCrossRefGoogle Scholar
  38. 38.
    Welch TJ, LeRoy AJ (1997) Helical and electron beam CT scanning in the evaluation of renal vein involvement in patients with renal cell carcinoma. J Comput Assist Tomogr 21:467–471PubMedCrossRefGoogle Scholar
  39. 39.
    Kaufman LB, Yeh BM, Breiman RS, et al. (2005) Inferior vena cava filling defects on CT and MRI. AJR 185:717–726PubMedCrossRefGoogle Scholar
  40. 40.
    Catalano C, Fraioli F, Laghi A, et al. (2003) High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. AJR 180:1271–1277PubMedGoogle Scholar
  41. 41.
    Hallscheidt PJ, Bock M, Riedasch G, et al. (2004) Diagnostic accuracy of staging renal cell carcinomas using multidetector-row computed tomography and magnetic resonance imaging: a prospective study with histopathologic correlation. J Comput Assist Tomogr 28:333–339PubMedCrossRefGoogle Scholar
  42. 42.
    Hallscheidt PJ, Fink C, Haferkamp A, et al. (2005) 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 29:64–68PubMedCrossRefGoogle Scholar
  43. 43.
    Lawrentschuk N, Gani J, Riordan R, et al. (2005) Multidetector computed tomography vs. magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review. Br J Urol 96:291–295Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Ranka Stern Padovan
    • 1
  • Drazen Perkov
    • 1
  • Ranko Smiljanic
    • 1
  • Bozidar Oberman
    • 1
  • Kristina Potocki
    • 1
  1. 1.Clinical Institute of Diagnostic and Interventional RadiologyClinical Hospital Center Zagreb, University of Zagreb, School of MedicineZagrebCroatia

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