The Egyptian Journal of Radiology and Nuclear Medicine (Jun 2017)

Multiparametric-MRI as a comprehensive study in evaluation, characterization & local staging of urinary bladder carcinomas

  • Ahmed Hafez Afifi,
  • Tarek Abdel Samie Abdel Maksoud,
  • Khaled Ibrahim EL-noueam,
  • Mohamed A. Ataa,
  • Dina Mohamad Abdallah

DOI
https://doi.org/10.1016/j.ejrnm.2017.01.011
Journal volume & issue
Vol. 48, no. 2
pp. 493 – 507

Abstract

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Objectives: To evaluate role of multiparametric-MRI as comprehensive technique for determining local staging of UB cancer and predicting histological grading of lymphadenopathy. Materials and methods: Fifty patients diagnosed as cancer bladder prospectively included and mp-MRI data were interpreted. Multiparametric techniques included added role of high resolution T2 weighted images (HR T2WI), diffusion weighted MRI (DW-MRI) and dynamic contrast enhanced MRI (DCE-MRI). Accuracy of these techniques separately and in conjunction were evaluated using histopathological findings as reference gold standard. Diagnosis of bladder cancer was performed either clinically, through urine cytology or using other radiologic investigations including ultrasonography or computed tomography. Results: Histopathological confirmation for local T staging done in 40 patients (80%) using cystoscopy/biopsy or from transurethral resection of bladder tumors (TURT) and in 10 patients (20%) from radical cystectomy. Metastatic lymphadenopathy was histopatholgically proved after radical cystectomy in 5 patients (10%), of them 3 were stage N1 and 2 were stage N2. Diagnostic accuracy of mp-MRI (88%) was superior to DW-MRI (82%), DCE-MRI (74%) and high resolution T2W-MRI (52%) in differentiating non-muscle invasive from muscle invasive and in differentiating organ-confined from non organ-confined tumors respectively. The agreement between the mp-MRI and histopathological staging were greater than DW-MRI (κ = 0.679), DCE-MRI (κ = 0.566) and high resolution T2W-MRI (κ = 0.274). Over staging decreased from (48%) using high resolution T2W or (26%) using DCE-MRI, or (18%) using DW to (12%) using multiparametric-MRI. Low ADC values and time-intensity curve were compared with histological grades and showed significant correlation. Size criteria of the lymph nodes, their restriction and low ADC values in DW-MRI suggest their metastatic nature. Conclusion: Mp-MRI is comprehensive & effective tool for determining local T stages, and the histological grades of urinary bladder cancers. Also, it predicts nature & stages of local lymph nodes, exhibiting high diagnostic performance with excellent objectivity.

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