[多种影像学检查在诊断肾细胞癌合并下腔静脉瘤栓及单纯血栓中的比较]
[Comparison of various imaging in the diagnosis of renal cell carcinoma with inferior vena cava tumor thrombus combined with bland thrombus].
作者信息
Li L W, Liu Z, Wang G L, Zhang H, Chen W, Ma J, Zhang L, He W, Ma L L, Wang S M
机构信息
Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China.
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Aug 18;51(4):678-683. doi: 10.19723/j.issn.1671-167X.2019.04.014.
OBJECTIVE
To analyse the clinical and imaging data of patients with renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT), and to assess the diagnostic efficacy of ultrasound, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) in the diagnosis of RCC with IVCTT combined with bland thrombus was assessed.
METHODS
We retrospectively analyzed the clinical and imaging data of 56 RCC patients with IVCTT who underwent radical nephrectomy and IVC thrombectomy between January 2014 and July 2018 in Department of Urology, Peking University Third Hospital. All the patients underwent US, enhanced CT and enhanced MRI preoperatively, and all the cases were confirmed with RCC with IVCTT by histological evaluation.
RESULTS
The criteria of RCC with IVCTT combined with bland thrombus was confirmed by intraoperative observation and postoperative pathology. The 56 patients were divided into bland thrombus group (n=18) and non bland thrombus group (n=38). Compared the two groups, it was found that the length of IVCTT was longer [(10.50 ± 5.55) cm vs.(6.66 ± 3.73) cm, P=0.014]; the ratio of diameter of IVCTT to maximum coronal diameter of IVC was closer to 1 [1.0 (0.7, 1.0) vs. 0.9 (0.2, 1.0), P=0.004]; the proportion of lower limb edema was higher [66.7(12/8)% vs.5.3%(2/36), P=0.005]；the proportion of segmental resection or interrupt of IVC was higher [66.7%(12/18) vs.15.8%(6/38), P<0.001], with statistical significance. Compared with the three imaging methods of US, enhanced CT and MRI, the highest sensitivity was MRI (77.8%), the highest specificity was enhanced MRI and enhanced CT (97.4%), the highest accuracy was enhanced CT and enhanced MRI (83.9%), the highest positive predictive value was enhanced CT (90.9%) and the highest negative predictive value was enhanced MRI (89.2%).
CONCLUSION
For the patients that RCC with IVCTT combined with bland thrombus, the length of IVCTT is longer, and the ratio of the diameter of IVCTT to the maximum corona diameter of IVC is closer to 1, and more likely to cause lower limb edema. Preoperative comprehensive evaluation of multiple images is needed to improve the accuracy of diagnosis.
目的
分析肾细胞癌（RCC）合并下腔静脉瘤栓（IVCTT）患者的临床及影像资料，评估超声、增强计算机断层扫描（CT）及增强磁共振成像（MRI）对RCC合并IVCTT及单纯血栓的诊断效能。
方法
回顾性分析2014年1月至2018年7月在北京大学第三医院泌尿外科行根治性肾切除术及下腔静脉血栓切除术的56例RCC合并IVCTT患者的临床及影像资料。所有患者术前均接受超声、增强CT及增强MRI检查，所有病例均经组织学评估确诊为RCC合并IVCTT。
结果
术中观察及术后病理证实RCC合并IVCTT及单纯血栓的标准。56例患者分为单纯血栓组（n = 18）和非单纯血栓组（n = 38）。比较两组发现，IVCTT长度更长[（10.50±5.55）cm对（6.66±3.73）cm，P = 0.014]；IVCTT直径与下腔静脉最大冠状径之比更接近1[1.0（0.7，1.0）对0.9（0.2，1.0），P = 0.004]；下肢水肿比例更高[66.7（12/18）%对5.3%（2/38），P = 0.005]；下腔静脉节段性切除或中断的比例更高[66.7%（12/18）对15.8%（6/38），P<0.001]，差异有统计学意义。与超声、增强CT和MRI三种成像方法相比，MRI的敏感性最高（77.8%），增强MRI和增强CT的特异性最高（97.4%），增强CT和增强MRI的准确性最高（83.9%），增强CT的阳性预测值最高（90.9%），增强MRI的阴性预测值最高（89.2%）。
结论
对于RCC合并IVCTT及单纯血栓的患者，IVCTT长度更长，IVCTT直径与下腔静脉最大冠状径之比更接近1，且更易引起下肢水肿。术前需要进行多图像综合评估以提高诊断准确性。
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