Diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound in differentiating bland from inferior vena cava tumor thrombus

Abstract

Objective To evaluate the diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound (CEUS) in differentiating bland from inferior vena cava tumor thrombus. Methods From October 2017 to March 2019, 60 cases of renal tumor who had inferior vena cava tumor thrombus and underwent laparoscopic surgery were selected. All patients underwent contrast-enhanced ultrasound before and during the operation to determine whether the tumor thrombus was combined with bland thrombus in typical enhancement mode, and postoperative pathological results were finally obtained. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative and intraoperative contrast-enhanced ultrasound were statistically analyzed. Results All 60 patients with IVC tumor thrombus underwent robot-assisted laparoscopic radical nephrectomy and IVC thrombectomy. The tumor thrombus was accompanied by bland thrombus in ten cases. Two cases of bland thrombus were missed by preoperative contrast-enhanced ultrasound, and the necrotic tissues in the head of tumor thrombus in another two cases were misdiagnosed as bland thrombus by both pre-and intra-operative CEUS. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative CEUS in differentiating bland thrombus from tumor thrombus were 80.0%, 96.0%, 93.3%, 80.0%, and 96.0%, respectively; the corresponding values of intraoperative CEUS were 100.0%, 96.0%, 96.7, 83.3%, and 100.0%. Conclusion Preoperative and intraoperative contrast-enhanced ultrasound performs well in the differential diagnosis of inferior vena cava tumor thrombus from bland thrombus, and it can provide important information and basis for the choice of operation mode, which is highly valuable in clinical application. Key words: Contrast-enhanced ultrasound; Inferior vena cava; Tumor thrombus; Thrombus