Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing 100034, China.
Chin Med J (Engl). 2009 Oct 5;122(19):2299-302.
We used abdominal ultrasound scan (USS), computed tomography (CT) and magnetic resonance imaging (MRI) findings in venous spread of renal cell carcinoma (RCC) to determine the superior extent of inferior vena cava (IVC) thrombus and IVC wall invasion and compared them with surgical and pathological reports.
From January 1999 to August 2007, 25 patients were diagnosed with RCC with IVC tumour thrombus. Before their operation, all patients had USS, contrast enhanced CT and MRI to find the superior extent of tumour thrombus and IVC wall invasion. All postprocessing techniques were performed by experienced radiologists. Two pathologists reported on all pathology specimens. The superior extent of tumour thrombus was confirmed by the senior surgeon at each operation, using the levels of thrombus defined according to 2004 Mayo Clinic classification. The radiographic results were compared with surgical and pathological findings.
All patients had radical nephrectomy and tumour thrombus excision. Eight patients had RCC on the left side and 17 on the right side. According to the clinical and pathological findings, 6 patients had level I tumour thrombus, 9 level II, 5 level III and 5 level IV. Six patients had IVC wall invasion. No patient had evidence of lymph node or distant metastases. Of the 25 patients, USS correctly diagnosed the superior extent of tumour thrombus in 18/25, CT 23/25 and MRI 23/25. USS found 1 case of IVC wall invasion preoperatively.
Multidetector computed tomography and magnetic resonance imaging are comparable and more effective than abdominal ultrasound in diagnosing inferior vena cava tumour thrombus in renal cell carcinoma. None of the three methods can detect inferior vena cava wall invasion.
我们使用腹部超声扫描（USS）、计算机断层扫描（CT）和磁共振成像（MRI）来确定肾细胞癌（RCC）静脉扩散的下腔静脉（IVC）血栓和 IVC 壁侵犯的上界，并将其与手术和病理报告进行比较。
1999 年 1 月至 2007 年 8 月，25 例患者被诊断为伴有 IVC 肿瘤血栓的 RCC。在手术前，所有患者均进行 USS、增强 CT 和 MRI 检查，以确定肿瘤血栓和 IVC 壁侵犯的上界。所有后处理技术均由经验丰富的放射科医生进行。两名病理学家对所有病理标本进行报告。根据 2004 年 Mayo 诊所分类定义的血栓水平，由每位手术的高级外科医生确认肿瘤血栓的上界。将影像学结果与手术和病理结果进行比较。
所有患者均接受根治性肾切除术和肿瘤血栓切除术。8 例患者左侧 RCC，17 例右侧 RCC。根据临床和病理发现，6 例患者为 I 级肿瘤血栓，9 例为 II 级，5 例为 III 级，5 例为 IV 级。6 例患者有 IVC 壁侵犯。没有患者有淋巴结或远处转移的证据。在 25 例患者中，USS 正确诊断肿瘤血栓上界的有 18/25 例，CT 为 23/25 例，MRI 为 23/25 例。USS 术前发现 1 例 IVC 壁侵犯。
多排 CT 和 MRI 在诊断 RCC 下腔静脉肿瘤血栓方面与腹部超声相当，甚至更有效。这三种方法均不能检测到下腔静脉壁侵犯。
