Accuracy of Magnetic Resonance Imaging Compared to Computerized Tomography and Renal Selective Angiography in Preoperatively Staging Renal Cell Carcinoma

Abstract

During 1986 and 1987, 47 patients with renal cell carcinoma were evaluated preoperatively with CT, angiography and MRI. The preoperative tumor stage (T), lymph node metastases and venous involvement determined with the three methods were compared to the operative and histopathological findings. For T stage, angiography proved less accurate (54%) than CT (64%) or MRI (63%). MRI was found to be superior to CT in assessing lymph nodes, with an overall accuracy of 89% and sensitivity of 100% compared to 77 and 60%, respectively, of CT. For venous involvement CT was overall more accurate (74%) than angiography (65%) or MRI (63%). All three methods expressed a low sensitivity (between 31 and 41%) and a high specificity (between 95 and 100%) for detecting venous involvement. The minimal advantages of MRI compared to its high cost do not justify its routine use. CT remains the method of choice in staging preoperatively renal cell carcinoma.

Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives

“…However, conventional CT has a lower sensitivity in delineating the superior margin of the thrombus when compared to MRI (76% and 100% respectively). The evolution of multidetector (MS) CT; which provides a three-dimensional rotational CT image, improved CT sensitivity in RCC (up to 95%)11 by accurately demonstrating the relationship of the renal mass with the renal tissue and adjacent organs and vessels and facilitating detection of tumor thrombi and distant metastases hence accurate staging and operative planning 12. The drawbacks of MS CT include (1) renal vein tapering and failure of visualization of tumor thrombi due to failure of contrast medium inflow to the IVC in the presence of an extensive tumor thrombus or by an external renal vein or caval compression by an adjacent metastatic tumor or enlarged lymph nodes and (2) failure to precisely delineate the cephalad extent of the thrombus as blood and thrombus radiological densities can be similar 10…”

Preoperative Staging of Renal Cell Carcinoma With Inferior Vena Cava Thrombus Using Multidetector CT and MRI

“…Computed tomography in incremental and spiral technique detects caval thrombi with sensitivities of 64 to 95%. [15][16][17] MRI has been reported to have a sensitivity of up to 100% in detecting caval thrombi. 9,18,19 MRI proved to be superior to spiral CT for thrombus detection and staging and has replaced venacavography as the gold standard.…”

“…2), and a coronal T1-weighted GE sequence (TR 136.6 ms, TE 4.1 ms, slice thickness 6 mm) with Gd-DTPA and transverse T1-weighted fat suppression sequence (TR 177.5 ms, TE 2.6 ms). In addition, a multiphase 3D angiography (15,30, 60, 90, 120 seconds, TR 3.2 ms, TE 1.1 ms, slap 80 mm, reconstructed partition thickness 1.25 mm, partitions 64, matrix 150*256, FoV 263*350) was performed after Gd-DTPA injection.…”

Color flow sonographic mapping of intravascular extension of malignant renal tumors

“…Miles and colleagues 8 advocated the use of dynamic bolus CT at the level of the renal veins to predict venous involvement of renal cell carcinoma. Constantinides and associates 5 showed CT to be more accurate than angiography or MR imaging in predicting venous involvement of renal cell carcinoma. In that series of 47 patients, the accuracy of CT was 74%, in comparison to 65% for angiography and 63% for MR imaging in predicting venous involvement with tumor.…”