Multimodality Imaging of Tumour Thrombus

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Presentation transcript:

Multimodality Imaging of Tumour Thrombus Saurabh Rohatgi, MD, Stephanie A. Howard, MD, Sree Harsha Tirumani, MD, Nikhil H. Ramaiya, MD, Katherine M. Krajewski, MD Canadian Association of Radiologists Journal Volume 66, Issue 2, Pages 121-129 (May 2015) DOI: 10.1016/j.carj.2014.11.001 Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 1 An 84-year-old male with pancreatic cancer. (A) Transverse grayscale ultrasound image showing echogenic tumour thrombus with expanded portal vein (PV; arrowhead) and splenic veins (arrow). Transverse color Doppler image showing absence of flow in the PV (arrow,B) and low-resistance arterial waveform seen in the main PV (C). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 2 A 62-year-old male with hepatocellular carcinoma (HCC). Transverse color Doppler images showing portal vein thrombosis (arrow,A), with subsequent cavernous transformation of portal vein (B). Note the presence of large collateral vessels adjacent to the portal vein with hepatopedal flow (arrow). Contrast-enhanced axial computed tomography image (C) redemonstrates cavernous transformation of the portal vein (arrow), with HCC mass located separate from the portal vein (arrowhead) and ascites. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 3 A 46-year-old female with metastatic leiomyosarcoma. Coronal contrast-enhanced computed tomography image shows bland filling defects in bilateral common femoral veins representing bland common femoral deep vein thromboses (arrows). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 62-year-old male with hepatocellular carcinoma. Axial contrast-enhanced computed tomography image shows expanded and enhancing thrombus in the main portal vein (arrow). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 77-year-old male with hepatocellular carcinoma. (A) Axial contrast-enhanced computed tomography image shows an expanded, heterogeneously enhancing thrombus in the inferior vena cava (arrow). (B) Axial contrast-enhanced computed tomography image shows enhancing thrombus in the right atrium (arrow). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 6 A 66-year-old female with adrenal cortical carcinoma. Coronal contrast-enhanced computed tomography image shows a large, heterogeneous, expansile mass arising from the right adrenal gland with invasion into the right hepatic lobe (arrowhead) and inferior vena cava (arrow). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 7 A 66-year-old female with lung cancer. Axial contrast-enhanced computed tomography image shows primary lung cancer invading into the left pulmonary artery (arrow). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 8 A 79-year-old male with lower extremity perivascular epithelioid cell tumor (PEComa; arrowhead). Coronal (A, B) and axial (C) contrast-enhanced computed tomography images show a heterogeneously enhancing tumour thrombus within the dilated left external iliac and common femoral veins (arrows). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 9 A 69-year-old female with metastatic ovarian cancer. Coronal contrast-enhanced magnetic resonance imaging (A) and coronal computed tomography (B) image show coexistent bland (arrow) and tumour (arrowhead) thrombus invading the inferior vena cava. Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 10 A 50-year-old male with metastatic rectal cancer. Coronal contrast-enhanced computed tomography images show a liver metastasis invading into the inferior vena cava and right atrium (arrow). A more discrete non enhancing bland thrombus is seen in the right atrium (arrowhead). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 11 A 58-year-old male with renal cell carcinoma. Coronal contrast-enhanced magnetic resonance imaging showing enhancing tumour thrombus extending from the renal veins into the inferior vena cava with marked dilatation and expansion (arrow). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 12 A 62-year-old male with hepatocellular carcinoma (HCC). Axial contrast magnetic resonance imaging showing a large HCC mass (arrowhead) with enhancing thrombus in the adjacent portal vein (arrow). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure: 13 A 63-year-old male with renal cell carcinoma. Coronal contrast magnetic resonance imaging showing extension of tumour thrombus into the renal (arrow) and adrenal veins (arrowhead) in a patient with a left adrenal metastasis. Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 14 A 63-year-old male with thyroid cancer. (A) Axial post contrast magnetic resonance imaging showing tumour thrombus in the right internal jugular vein (arrow) with contiguous thyroid mass (arrowhead). (B) Coronal images from F-18 fluorodeoxyglucose (FDG)/positron emission tomography/computed tomography showing intense FDG uptake in the right internal jugular vein (arrow) consistent with tumoural thrombus. The avidity is similar to the primary thyroid mass (arrowhead). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 15 A 62-year-old male with hepatocellular carcinoma on antiangiogenic therapy. Axial contrast-enhanced computed tomography images show an expanded and enhancing thrombus in the main portal vein prior to start of treatment (arrowhead) (A). The posttreatment scan (B) shows resolution of enhancement within the tumour thrombus, now of homogenous low attenuation (arrow), representing a treatment effect. Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 16 A 58-year-old male patient with renal cell carcinoma on antiangiogenic therapy. Pretreatment coronal contrast-enhanced computed tomography scan (A) shows a combination of enhancing tumoural thrombus (arrowheads) and low attenuation bland thrombus in the inferior vena cava (arrow). Posttreatment coronal contrast-enhanced computed tomography scan (B) shows resolution of enhancement within the tumour component of the thrombus (arrow), and decreasing tumour burden (not shown). Canadian Association of Radiologists Journal 2015 66, 121-129DOI: (10.1016/j.carj.2014.11.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions