Abstract
Background: Renal cell carcinoma (RCC) thrombus invasion in the inferior vena cava (IVC) wall needs adequate resection to improve survival. Surgical planning to avoid positive vascular surgical margins and recurrent disease can be facilitated by imaging capable of diagnosing this invasion and the extent of the thrombus. Objective: To evaluate the diagnostic performance of multiparametric MR imaging (mpMRI) for detecting inferior vena cava (IVC) wall invasion and extent of renal cell carcinoma (RCC) thrombus. Methods: In this prospective study, twenty consecutive patients underwent mpMRI before open radical nephrectomy with IVC thrombectomy was performed in a single high-volume institution by one urologist (PM) blinded for mpMRI findings. Primary endpoint was mpMRI negative- and positive predictive value (NPV/PPV) for IVC wall invasion as encountered during surgery. IVC wall invasion was assessed on mpMRI by a radiologist prior to the surgery based on qualitative imaging parameters. Also, NPV and PPV were calculated with incremental use of quantitative parameters. Therefore, the association between IVC wall invasion and the maximum IVC and renal vein orifice diameter, and the cranial extent of the thrombus was evaluated by logistic regression. After ROC analysis an optimal cut-off point was selected for significantly associated quantitative parameters. NPV and PPV were calculated using this optimal cut-off point. Results: mpMRI NPV and PPV for IVC wall invasion based on qualitative parameters was 82% and 100%, respectively. An increase in IVC diameter was significantly associated with IVC wall invasion (p < 0.05). With incremental use of an IVC diameter cut-off value of 27 mm NPV and PPV for IVC wall invasion were 100% and 89%, respectively. Conclusion: mpMRI is able to reliably diagnose IVC wall invasion of RCC thrombus and can optimize radical surgical resection.
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