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I'm Dr. P, back with our 5-year-old that

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3 00:00:02,630 --> 00:00:04,370 has a renal mass and Wilms tumor.

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And I want to talk to you a little bit about

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renal vascular, especially renal vein invasion.

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And some of you, myself included, might

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have been concerned on prior vignettes

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about the status of the right renal vein.

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And that's why you have to understand what

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pulsing sequences are reliable, or you’ve

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got to pick the right horse for the right job.

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So on the left, we've got a water

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weighted spinecho with fat suppression.

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And at first glance, it looks like there's

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something in the right renal vein, and maybe

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even something in the inferior vena cava.

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On the other hand, I've got

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two other pulsing sequences.

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I've got another T2 on the far right.

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I'm going to ignore that for now.

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But in the middle, I've got a thin section,

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water weighted, balanced turbo field echo, or

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said another way, a heavily water weighted,

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thin section, breath hold, gradient echo image.

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Now, I'm going to blow that up for you.

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Remember, this patient presented incidentally

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with an enlargement of the abdomen

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and a palpable mass by the parents.

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But Wilm's tumor can present with malaise

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and pain and even hypertension,

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especially if the vessels are involved.

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Microscopic hematuria is found

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about 25 percent of the time in

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children who present with this disorder.

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Fortunately, the majority of these tumors are

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solitary, but about 12 percent are multifocal

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in one kidney, and 7 percent develop synchronous

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or metachronous bilateral renal tumors.

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So let's go back to our renal vein for

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a moment, and we've got our aorta; everybody

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can see that, and there's our renal artery.

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And our renal artery is clean, it's not encased,

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there's no adenopathy between it and the adjacent

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vasculature, and there's no adenopathy behind it.

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Let's go to the cava now, and

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there is our renal artery.

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So what was happening was we were volume averaging

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and creating some mismapping in the combination

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of the renal artery and vein, which we weren't

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separating out very well on the water weighted

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image, but here we can separate them out just fine.

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And look at how thin and collapsed

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and delicate our renal vein really is.

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And look at how homogeneous our renal vein really is.

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Even without contrast administration on

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this water weighted GRE or turbo field echo

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with thin sections and breath holding that

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confirms we do not have renal vein invasion.

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So helpful.

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Dr. P out.