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The purpose of this study was to compare the ability of  18 F-FDG PET/CT and contrast-enhanced MRI (CEMRI) to detect and grade venous tumour thrombus (VTT) and venous bland thrombus (VBT) in RCC and assess invasion of the venous wall by VTT. The PET/CT and CEMRI data of 41 patients with RCC were retrieved. The difference in maximum standardized uptake value (SUVmax) between VTT and VBT was analysed. According to their pathological diagnosis, the patients were divided into those with and without venous wall invasion. The PET/CT and CEMRI features, including the SUVmax of the primary lesion and VTT, maximum venous diameter, complete occlusion of the vein by VTT, and VTT morphology, were compared between the two groups. All 41 patients had VTT, and eleven of the 41 patients had VBT. The mean SUVmax of the VTT (6.33 ± 4. 68, n = 41) was significantly higher than that of the VBT (1.37 ± 0.26, n = 11;  P  &lt; 0.001). Ten of the 11 cases of VBT were correctly diagnosed by  18 F-FDG PET/CT, and all 11 were diagnosed by CEMRI. Both  18 F-FDG PET/CT and CEMRI can effectively detect VTT and distinguish VTT from VBT.  18 F-FDG PET/CT is less effective in grading VTT than CEMRI. Complete venous occlusion by VTT indicates venous wall invasion.

Diagnostic value of 18F-FDG PET/CT versus contrast-enhanced MRI for venous tumour thrombus and venous bland thrombus in renal cell carcinoma