PMC7473983_01
Preoperative CT images of intraluminal leiomyosarcoma of IVC. (A) Axial unenhanced CT image shows a slightly hypoattenuated mass (white arrow) in the dilated inferior vena cava with nodular calcification. (B) Axial contrast-enhanced arterial phase CT image shows dilation of the inferior vena cava. The lumen is filled with a mass showing mild heterogeneous enhancement (white arrow). The boundary between IVC and the right liver lobe is ambiguous. (C and D) Axial contrast-enhanced venous phase CT image shows no significant enhancement in the centre of the mass (white arrow). The right posterior liver lobe shows heterogeneously inferior enhancement (star area), with right hepatic vein ill defined (white arrowheads). (E) Reconstructed coronal contrast-enhanced venous phase CT image shows the indistinct boundary between the tumour (white arrow) and the left renal vein (grey arrowhead with white outline). (F) Reconstructed coronal contrast-enhanced venous phase CT image shows the unclear (white arrow) boundary between right liver lobe and the hepatic segment of IVC (small black arrows).
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The left renal vein was pushed down and was not clearly demarcated from the mass (Figures 1 and 2).
CT 3D reconstruction shows the poorly filled IVC and bilateral renal vein coloured in blue, with the LMS coloured in green.
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The left renal vein was pushed down and was not clearly demarcated from the mass (Figures 1 and 2).
Preoperative axial T2-weighted black blood sequence with fat-suppressed MR image. (A) and T1-weighted with fat-suppressed MR image (B) shows the mass within the inferior vena cava with smooth vessel wall of IVC (white arrow). (C) Axial gadobutrol-enhanced late venous phase T1-weighted MR image shows heterogeneous enhancement of the mass (white arrow). The right hepatic vein is relatively hyperintense on T2WI (A) and enhanced T1WI images (C) (white arrowhead), without any abnormal signal intensity filling-defect. (D) Axial gadobutrol-enhanced T1-weighted fat-suppressed MR image shows the integrity of left renal vein, without any filling-defect (grey arrowhead).
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The thin layer T2-weighted black blood sequence revealed the integrity of the vessel walls of the left renal vein and the right hepatic vein (Figures 3-5).
Preoperative coronal enhanced T1WI images. (A) and T2-weighted black blood sequence with fat-suppressed images (B) shows the mass within IVC (white arrow) and the relationship between the mass and bilateral renal veins (arrow heads). The mass and the left renal vein are totally separated. Enhanced T1WI image proves the patency of bilateral renal veins, without any filling defect (white arrowhead). T2-weighted black blood sequence shows complete vessel wall of renal veins (grey arrowhead).
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The thin layer T2-weighted black blood sequence revealed the integrity of the vessel walls of the left renal vein and the right hepatic vein (Figures 3-5).
Liver parenchyma with oedema and congestion shows patchy hyperintensity on fat-suppressed T2-weighted axial MR image.
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The thin layer T2-weighted black blood sequence revealed the integrity of the vessel walls of the left renal vein and the right hepatic vein (Figures 3-5).
Preoperative diffusion-weighted images with b=50 (A) and b=800 (B) both show hyperintensity of the IVC mass (white arrow). (C) The tumour (white arrow) displays decreased apparent diffusion coefficients.
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On the diffusion-weighted image, the tumour showed hyper-intensity, with the corresponding apparent diffusion coefficient map showing areas of decreased coefficient within the lesion, suggesting a limited diffusion of water molecules in the tumour (Figure 6).
Gross pathology of the resected specimen from the patient.
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The scope of surgery was the same as that revealed on MRI, confirming that MRI is able to provide more precise evaluation than CT (Figure 7).
Photomicrograph of the tumour shows proliferating spindle-shaped cells with nuclear atypia in a braided arrangement. (HE stain, original magnificationx200).
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Postoperative histological and immunohistochemical analyses confirmed an IVC leiomyosarcoma (Figure 8).
(A) Postoperative coronal enhanced venous phase CT image demonstrates patency of the artificial IVC from the entrance of right atrium to level of the renal vein (white arrow). (B-D) Axial enhanced venous phase CT images show the reserved right hepatic vein (white arrowhead), left renal vein (grey arrowhead) and right renal vein (black arrow). They are all well filled with contrast agent and perfectly connected to the artificial IVC (white arrow).
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Local haemorrhage was detected, but without active bleeding (Figures 9 and 10).
Postoperative CT 3D reconstruction shows the artificial IVC vessel coloured in yellow. The remaining lower segment of IVC and bilateral renal vein are coloured in blue.
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Local haemorrhage was detected, but without active bleeding (Figures 9 and 10).