Rolul IRM în evaluarea şi managementul extensiei venoase în carcinomul renal cu celule clare1.

Objectives. This study aims to present performance and limitations of magnetic resonance imaging (MRI) in detection and characterization of venous tumor extension in patients with renal cell carcinoma (RCC) and in assessing its resectability, in order to select the most appropriate surgical techniques. Material and method. Retrospective study conducted on a total of 39 patients (29 men and 10 women, age range 41-83 years, mean age 58.7) who underwent surgical treatment in Urological Surgery Center, Renal Dialysis and Kidney Transplant in Fundeni Hospital from January 1st 2008 to December 31st 2009 for renal cell carcinoma, to which the pathological examination revealed the presence of venous tumor extension on renal vein and / or inferior vena cava and who performed preoperative MRI with contrast. Images obtained by MRI evaluation were assessed for the presence of tumor thrombus, its level (including any extension into the contralateral renal vein or hepatic veins), vessel wall adherence or invasion, and tumor staging. MRI results were compared with surgical and pathological findings. Results and discussions: 28 patients (71.7%) had RCC on the right side and 11 patients (28.3%) on the left side. According to TNM classification, clinical and histopathological findings, 34 patients (87.1%) with clear cell carcinomas are in T3b stage and five patients (12.9%) are in T3c stage. MRI accurately predicted venous tumor extension in 36 patients (92.3%). In all 3 patients (7.7%) in which MRI did not reveal the presence of tumor thrombus, the pathological exam showed its presence in the segmental branches of renal vein. Conclusions. MRI is a reference imaging method in diagnosing the presence of tumor thrombus, characterizing the nature of the thrombotic process as well as appreciating the higher level of tumor thrombus in renal cell carcinoma, the limits of the method is found in cases showing tumor extension into the segmental branches of renal vein. It is also a sensitive technique for detecting vessel wall invasion and provides important preoperative information for surgical planning. [ABSTRACT FROM AUTHOR]