Ultrasound semiotics of tumor thrombosis of leiomyosarcoma of the inferior vena cava: a prospective study

Introduction: Patients with tumor thrombosis of the inferior vena cava leiomyosarcoma should not be considered inoperable; they are subject to radical treatment, which can significantly prolong their lives. Only a multiparametric approach to diagnosis will allow clinicians to have a complete picture of the severity of the patient’s condition in order to make a decision on the choice of the optimal treatment method.

Objective: Improvement of the results of ultrasound semiotics and the use of multiparametric ultrasound examination of tumor thrombosis of leiomyosarcoma of the inferior vena cava.

Materials and methods: The study included 26 leiomyosarcomas of the IVC identified by CT with intravenous contrast, and 14 of them were patients with tumor thrombosis of the IVC.

Results: In our observations, the main localization of the primary tumor of the inferior vena cava is the level of the infrarenal, cavarenal, and suprarenal segments of the IVC, and the upper border of the tumor thrombus is below the level of the diaphragm, and only in two cases there was an incomplete occlusion of the hepatic vein orifice. In all other cases, the apex of the tumor thrombus was determined at the level of the suprarenal segment of the IVC. The standard situation was the tumor germination of all layers of the IVC wall, regardless of localization and semicircle, the tumor thrombus in the IVC lumen originated from the main tumor mass and spread in the direction of blood flow. In the preliminary assessment, when comparing the data of complex ultrasound diagnostics (B-mode, shear pulse-wave elastography and elastometry) of the leiomyosarcoma of the IVC with tumor thrombosis and in comparison with the data of the study of the macropreparation — tumor and tumor thrombosis, there was a complete coincidence, where p<0.05. This suggests that the results obtained are statistically significant.

Discussion: Comprehensive ultrasound diagnostics, thanks to additional techniques, allows you to assess blood flow in the vessels affected by the tumor and in the formed collateral systems, assess the speed of blood flow, as well as the presence of parietal blood flow, allows you to assess the qualitative and quantitative characteristics of tumor thrombosis, differentiate the tumor thrombus of the VCI from hemorrhagic thrombosis, and also differentiate the leiomyosarcoma of the inferior vena cava from nonorgan tumors of the retroperitoneal space or extra-organ tumors originating from the right kidney, adrenal gland and liver.

Conclusion: Multiparametric ultrasound diagnostics allows to assess: the prevalence of leiomyosarcoma of the inferior vena cava, the presence of tumor thrombosis, its boundaries and nature (occlusive, floating), the spread of tumor thrombosis to other vessels (to the hepatic, renal, lumbar, iliac veins, gonadal veins) or in the heart cavity, the structure of the tumor thrombus (soft, loose, dense, mixed). Thanks to comprehensive ultrasound diagnostics it is possible to assess the development of Badda-Kiari syndrome, give clear criteria that can influence the tactics of surgical intervention (indications and contraindications to the operation), ultrasonic monitoring in the postoperative period, in the detection of postoperative complications.

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