Diagnostic value of 18F-FDG PET/CT versus contrast-enhanced MRI for venous tumour thrombus and venous bland thrombus in renal cell carcinoma

An-Hui Zhu,Xiao-Yan Hou,Shuai Tian,Wei-Fang Zhang

doi:10.1038/s41598-021-04541-9

An-Hui Zhu, Xiao-Yan Hou + Show 2 more

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https://doi.org/10.1038/s41598-021-04541-9

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Abstract

The purpose of this study was to compare the ability of 18F-FDG PET/CT and contrast-enhanced MRI (CEMRI) to detect and grade venous tumour thrombus (VTT) and venous bland thrombus (VBT) in RCC and assess invasion of the venous wall by VTT. The PET/CT and CEMRI data of 41 patients with RCC were retrieved. The difference in maximum standardized uptake value (SUVmax) between VTT and VBT was analysed. According to their pathological diagnosis, the patients were divided into those with and without venous wall invasion. The PET/CT and CEMRI features, including the SUVmax of the primary lesion and VTT, maximum venous diameter, complete occlusion of the vein by VTT, and VTT morphology, were compared between the two groups. All 41 patients had VTT, and eleven of the 41 patients had VBT. The mean SUVmax of the VTT (6.33 ± 4. 68, n = 41) was significantly higher than that of the VBT (1.37 ± 0.26, n = 11; P < 0.001). Ten of the 11 cases of VBT were correctly diagnosed by 18F-FDG PET/CT, and all 11 were diagnosed by CEMRI. Both 18F-FDG PET/CT and CEMRI can effectively detect VTT and distinguish VTT from VBT. 18F-FDG PET/CT is less effective in grading VTT than CEMRI. Complete venous occlusion by VTT indicates venous wall invasion.

Highlights

The purpose of this study was to compare the ability of 18F-FDG positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) (CEMRI) to detect and grade venous tumour thrombus (VTT) and venous bland thrombus (VBT) in Renal cell carcinoma (RCC) and assess invasion of the venous wall by VTT
Assessment of patients based on 18F‐FDG PET/CT and contrast-enhanced MRI (CEMRI)
On CEMRI, all 34 clear RCCs were enhanced, and the 7 type 2 papillary renal carcinomas showed uneven or low enhancement compared to the clear RCCs

Summary

Introduction

The purpose of this study was to compare the ability of 18F-FDG PET/CT and contrast-enhanced MRI (CEMRI) to detect and grade venous tumour thrombus (VTT) and venous bland thrombus (VBT) in RCC and assess invasion of the venous wall by VTT. The difference in maximum standardized uptake value (SUVmax) between VTT and VBT was analysed According to their pathological diagnosis, the patients were divided into those with and without venous wall invasion. 18F-FDG positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced MRI (CEMRI) scans of a 67-year-old man who had clear cell carcinoma of the left kidney with a level IV venous tumour thrombus (VTT) and venous bland thrombus (VBT). The site of pathologically increased FDG uptake (SUVmax 5.7) on the PET and PET/CT images from the left renal vein to the inferior vena cava is the VTT (red arrow) (a, b). The VTT with a regular shape shows heterogeneous enhancement and completely occludes the inferior vena cava lumen on coronal CEMRI (red arrow) (c), while the VBT shows no enhancement (white arrow) (c)

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