Cancer Management and Research (Aug 2020)

A Case of a Huge Inferior Vena Cava Leiomyosarcoma: Precise Preoperative Evaluation with Gadobutrol-Enhanced MRI

  • Zhou X,
  • Wang M,
  • Li S,
  • Cai H,
  • Liang L,
  • Li ZP,
  • Feng ST,
  • Peng Z,
  • Li X

Journal volume & issue
Vol. Volume 12
pp. 7929 – 7939

Abstract

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Xiaoqi Zhou,1,* Meng Wang,1,* Shaoqiang Li,2 Huasong Cai,1 Lijian Liang,2 Zi-Ping Li,1 Shi-Ting Feng,1 Zhenpeng Peng,1 Xuehua Li1 1Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People’s Republic of China; 2Department of Hepatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhenpeng Peng; Xuehua Li Email [email protected]; [email protected]: Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour with poor prognosis. Surgical resection is the first line of treatment to achieve the best possible outcome. However, precise preoperative evaluation is essential to guide therapeutic decisions. Here, the preoperative evaluation potential of gadobutrol-enhanced magnetic resonance imaging (MRI) was assessed in the management of a 42-year-old patient with a large IVC mass.Methods: The patient first underwent enhanced computed tomography (CT), but the relationship between the left renal vein and the mass in the dilated IVC was ambiguous, and it remained unclear whether the right hepatic vein was invaded by the lesion. To make a precise assessment of the tumour, the patient subsequently underwent high-resolution MRI angiography examination combined with high-concentration contrast medium gadobutrol.Results: MRI demonstrated the integrity of the right hepatic vein and the left renal vein. Following a multidisciplinary consultation, a complicated surgery including complete resection of the mass, artificial vessel replacement of IVC, total hepatectomy, and bilateral nephrectomy with liver and kidney auto-transplantation was performed successfully. The surgical plan formulated after reviewing the MRI preoperatively was adhered to the course of the surgery. Postoperative CT re-examination showed that the blood flow of the artificial blood vessel and the right hepatic vein was unobstructed. Histopathological examination confirmed the tumour to be a leiomyosarcoma.Conclusion: Preoperative imaging diagnosis and assessment have important implications for the surgical planning of IVC leiomyosarcoma. High-resolution MRI angiography examination with high concentration contrast medium gadobutrol may be of particular benefit in IVC tumours.Keywords: leiomyosarcoma, inferior vena cava, preoperative care, magnetic resonance imaging, gadobutrol

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