Magnetic resonance imaging and magnetic resonance angiography before postchemotherapy retroperitoneal lymph node dissection.
OBJECTIVE
Retroperitoneal lymph node dissection (RPLND) after primary chemotherapy is an accepted therapeutic approach for metastatic nonseminomatous germ cell testicular cancer. Because of the intense desmoplastic reaction and adherence to venous and arterial walls, accurate imaging of the retroperitoneal vasculature and its relation to residual tumor is essential. We report our experience with magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), including the recently developed technique of bolus-contrast MRA, in patients undergoing postchemotherapy RPLND.


METHODS
Eighteen patients underwent MRI of the retroperitoneal region before RPLND. In addition to routine sequences, MRA was performed in 10 patients, including 8 with a three-dimensional technique using bolus intravenous MR contrast. Results were compared with intraoperative and pathologic findings.


RESULTS
MRI and MRA provided detailed information on retroperitoneal vasculature and its relation to tumor, including multiple renal vessels (n = 5), duplex inferior vena cava (n = 1), left retroaortic renal vein (n = 2), and common iliac vein thrombus (n = 1). In all cases, bolus-contrast MRA provided unique information on the location and number of renal and lumbar arteries, in addition to information on the aorta and the mesenteric and iliac vessels. The origin and number of renal arteries were accurately identified in all patients by bolus-contrast MRA; 2 patients had supernumerary renal arteries discovered at RPLND that had not been identified on non-bolus-contrast MRI.


CONCLUSIONS
Bolus-contrast three-dimensional MRA provides unique information on renal and lumbar vessels. The potential benefit of avoiding vascular injury during dissection should be prospectively evaluated.
Corral
D A
DA
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Varma
D G
DG
Jackson
E F
EF
Amato
R J
RJ
Donat
S M
SM
Pisters
L L
LL
D000328:Adult; D003287:Contrast Media; D018237:Germinoma / Q000175:diagnosis* / Q000556:secondary*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012079:Renal Circulation; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D013152:Splanchnic Circulation; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology*; D014652:Vascular Diseases / Q000175:diagnosis
D003287:Contrast Media