Renal carcinoma: diagnosis of venous invasion with Gd-enhanced MR venography

The aim of this study was to evaluate the usefulness of gadolinium-enhanced lime-of-flight magnetic resonance venography (MRV) in the diagnosis of bla nd thrombosis/tumoral invasion in the preoperative assessment of renal cell carcinoma. Pre I,Preoperative precontrast and enhanced GRE fast low-angle shot (FLASH) images of 36 patients with renal adenocarcinoma were reviewed and compared with pre- and post-contrast T1-weighted images. All patients u nderwent surgery, and MR findings were blindly and prospectively compared w ith surgical and pathologic data, considered the standard. Renal vein and v ena cava were involved in 17 and 9 patients, respectively; right atrial ext ension was present in one patient. Precontrast spin-echo (SE) and FLASH ima ges were 88% sensitive and 100% specific in the detection of venous involve ment, respectively, and enhanced FLASH images 100% sensitive and 96% specif ic. The nature of thrombus (neoplastic or bland) was more accurately assess ed (McNemar's, p < 0.05) with FLASH-enhanced MR images (sensitivity 89%; sp ecificity 96%) than with SE and precontrast FLASH images (sensitivity 79%; specificity 94%). Our data suggest that use of Gd-enhanced MRV might improv e preoperative assessment of vascular involvement in renal carcinoma.