Magnetic resonance imaging in the staging of renal cell carcinoma

Autor: David Chadwick, J. B. Penry, J. E. Kabala, Rajendra Persad, David Gillatt, J. C. Gingell
Rok vydání: 1991
Předmět:
Zdroj: The British Journal of Radiology. 64:683-689
ISSN: 1748-880X
0007-1285
DOI: 10.1259/0007-1285-64-764-683
Popis: A prospective study has been carried out to examine the role of magnetic resonance imaging (MRI) in the investigation of renal cell carcinoma in 24 patients. In all cases the inferior vena cava (IVC) was well demonstrated with MRI. In 14 out of 15 patients where surgical correlation was available, the MRI and operative staging were in agreement. Magnetic resonance imaging and computed tomographic (CT) staging were in agreement in 16 out of the 17 patients where both were performed. In one case, CT suggested hepatic invasion but this was found not to be present on MRI and at operation. Magnetic resonance imaging also provided substantial additional information in three patients, including two cases where MRI demonstrated a patent IVC that appeared occluded on CT (one of which also had vertebral metastases seen on MRI but missed on CT) and one case where CT failed to demonstrate minimal involvement of the IVC. Magnetic resonance imaging is an accurate means of staging renal cell carcinoma with clear advantages over CT. In no case in this series was inferior vena cavography found to be necessary. In the vast majority of patients with suspected renal cell carcinoma, intravenous urography (IVU) and ultra- sound will produce the diagnosis (Demas et al, 1988), occasionally with the addition of percutaneous biopsy. Further investigations will generally be directed towards staging the tumour. Involvement of the renal vein and inferior vena cava (IVC) will affect the surgical technique used (McDonald, 1982; Woodhouse et al, 1985; Pritchett et al, 1986) and the presence of invasion of regional lymph nodes or viscera and distant metastases has considerable prognostic significance (Skinner et al, 1972; Boxer et al, 1979; Lieber et al, 1981). Both ultrasound and computed tomography (CT) (especially dynamic CT) can be used to evaluate the IVC, regional lymph nodes and local invasion of the tumour. Although an accuracy of up to 91 % for CT has been reported (Johnson et al, 1987), an accuracy of 72-78% may be more realistic (Frohmuller et al, 1987; Didier et al, 1987; London et al, 1989; Miles et al, 1990). Problems with CT include inadequate or mistimed injec- tion of intravenous contrast medium and limitations of the transverse plane of the section may result in diffi- culty in evaluating the interface between the tumour and adjacent viscera (Demas et al, 1988). The purpose of this study was to determine the accu- racy of magnetic resonance imaging (MRI) staging of renal cell carcinomas, in particular with reference to IVC involvement and to see if inferior vena cavography can be regarded as obsolete in this situation.
Databáze: OpenAIRE
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