Bland thrombus featuring a uniform signal intensity and lack of enhancement after gadolinium can be distinguished from tumor thrombus, which exhibits intermediate or high signal intensity, heterogeneous intensity, and, more reliably, the presence of small vessels. In a recent study involving 81 patients with RCC, MRI was reported to have a 92% sensitivity, an 86% specificity, an 89% positive predictive value, and a 91% negative predictive value for identifying IVC wall invasion [69]. Pitfalls of MRI include the potential for large tumors to compress the vena cava and cause flow-related artifacts. Such artifacts can be reduced with appropriate saturation pulses. Although MRI of the abdomen with IV contrast is considered in all major guidelines as an adequate method for the staging of RCC, imaging the pelvis for RCC staging is considered optional in the guidelines [5,13]. There is no relevant literature with high-quality evidence regarding the use of MRI of the pelvis in the staging of RCC. Although it is likely that MRI pelvis may not offer additional information in most patients with early stage RCC, pelvic imaging can be helpful in patients with more advanced RCC, in whom metastatic spread is suspected [47,48]. MRI Abdomen MRI of the abdomen without and with IV contrast is considered to be a reliable method for the staging of RCC. Various MR sequences, including T2-weighted, chemical shift T1-weighted, contrast-enhanced T1-weighted, and diffusion-weighted images, are typically obtained for the staging of RCC. In a study involving 40 patients with Staging of Renal Cell Carcinoma RCC, MRI was reported to have an accuracy of 81% to 86% for T staging [62]. Breath-hold MRI showing a lack of perinephric fat involvement is reported to have a high negative predictive value for no perinephric tumor invasion [63].
Staging of Renal Cell Carcinoma. Bland thrombus featuring a uniform signal intensity and lack of enhancement after gadolinium can be distinguished from tumor thrombus, which exhibits intermediate or high signal intensity, heterogeneous intensity, and, more reliably, the presence of small vessels. In a recent study involving 81 patients with RCC, MRI was reported to have a 92% sensitivity, an 86% specificity, an 89% positive predictive value, and a 91% negative predictive value for identifying IVC wall invasion [69]. Pitfalls of MRI include the potential for large tumors to compress the vena cava and cause flow-related artifacts. Such artifacts can be reduced with appropriate saturation pulses. Although MRI of the abdomen with IV contrast is considered in all major guidelines as an adequate method for the staging of RCC, imaging the pelvis for RCC staging is considered optional in the guidelines [5,13]. There is no relevant literature with high-quality evidence regarding the use of MRI of the pelvis in the staging of RCC. Although it is likely that MRI pelvis may not offer additional information in most patients with early stage RCC, pelvic imaging can be helpful in patients with more advanced RCC, in whom metastatic spread is suspected [47,48]. MRI Abdomen MRI of the abdomen without and with IV contrast is considered to be a reliable method for the staging of RCC. Various MR sequences, including T2-weighted, chemical shift T1-weighted, contrast-enhanced T1-weighted, and diffusion-weighted images, are typically obtained for the staging of RCC. In a study involving 40 patients with Staging of Renal Cell Carcinoma RCC, MRI was reported to have an accuracy of 81% to 86% for T staging [62]. Breath-hold MRI showing a lack of perinephric fat involvement is reported to have a high negative predictive value for no perinephric tumor invasion [63].