Use of magnetic resonance imaging to determine surgical approach to renal cell carcinoma with vena caval extension.

Extension of renal cell carcinoma into the vena cava is found in 4 to 10 percent of patients. One key to successful surgical management is defining the superior extent of the thrombus. Currently, this is accomplished by using inferior venacavography. The limitations of this imaging technique include difficulty in defining the superior extent of the thrombus and determining the presence of hepatic vein involvement. We report our experience using magnetic resonance imaging (MRI) in 9 patients to stage the thrombus and to determine the operative approach. We believe that MRI supplants other imaging techniques for staging tumor thrombi in renal cell carcinoma.