Fig. 2
From: Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI
Images in a 69-year old woman with a clear cell renal cell carcinoma (RCC) and an inferior vena cava (IVC) tumor thrombus with wall invasion. The RCC extends from the right kidney into the IVC and extends into the right atrium. a axial fat-saturated T2-weighted image. b T1-weighted contrast-enhanced 3D GRE (VIBE) image contrast enhanced 3D GRE image (arterial phase) and (c), coronal T2-weighted HASTE image for anatomic reference. Note that the thrombus completely obstructs the lumen of the IVC, but also seems to breach the vessel wall (a, c). The contrast-enhanced image (b) demonstrates a heterogeneous enhancement of the tumor thrombus and a clear breach of the vessel wall (gray arrowhead), which is highly suggestive of IVC wall invasion. During extended nephrectomy, this thrombus showed strong adherence to the IVC wall and during extraction, circumferential cavectomy with vascular reconstruction became necessary. VIBE = Volumetric interpolated breath-hold examination