Abstract
ABSTRACTPurpose:To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC).Materials and Methods:We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two off-line readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed.Results:Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was an indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value.Conclusion:Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.
Highlights
4-10% of cases of renal cell carcinoma (RCC) are associated with inferior vena cava (IVC) tumor thrombus [1, 2]
Every Contrast-enhanced ultrasound (CEUS) examination was of sufficient quality to enable analysis and no relevant motion artefacts were encountered
The information from surgery and pathology confirmed the diagnosis of clear cell RCC in all the 30 patients who underwent nephrectomy with IVC thrombectomy
Summary
4-10% of cases of renal cell carcinoma (RCC) are associated with inferior vena cava (IVC) tumor thrombus [1, 2]. Bland thrombus is associated with adverse survival outcome in patients treated surgically for RCC with IVC tumor thrombus [5]. Discrimination of bland and tumor thrombus is of clinical significance for determining the therapeutic approach and predicting survival. Contrast-enhanced ultrasound (CEUS) is emerging as a valuable imaging modality that complements and enhances conventional vascular US imaging in clinical and scientific settings. US contrast agents are gas-filled microbubbles that are injected into the bloodstream and serve as strict intravascular reflectors of ultrasound waves, providing real-time assessment of the dynamic temporal and spatial heterogeneity of the macro-and micro-vascular perfusion [6]. Contrast-specific image processing techniques based on the nonlinear scattering properties from microbubbles allow enhancement of vascular structures and quantification of tissue perfusion. Previous reports have concluded that CEUS is an excellent method for differentiation of malignant from benign portal vein thrombosis in hepatocellular carcinoma [12,13,14]
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