Researching imaging characteristics and assessing values of MRI in the diagnosis of bladder cancer at T-stage

Nguyen Quang Toan1, Vu Dang Luu2, Bui Van Giang3,
1 Department of Diagnostic Imaging, K Hospital
2 Bach Mai hospital
3 Department of Diagnostic Imaging, K . Hospital

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Abstract

SUMMARY


Purpose: Describing imaging characteristics and assessing values of MRI in the diagnosis of bladder cancer at T-stage.
Subjects and methods: 43 patients with bladder tumors were selected to be in adescriptive study (38 of whom had tumors from tumor histopathology and 5 patients had histology from other organs or benign paraganglioma bladder tumor), in which they got diagnosed, operated (transurethral resection or radical cystectomy) and had pathology results from May 2017 to June 2018 at K hospital in Tan Trieu. All MRI films were evaluated preoperatively and compared with histopathology postoperativelydistinguishing superficial tumors (T1 or lower) and invasive tumors (T2 or higher).
Results: Among 38 patients being studied, the mean age is 56 ± 13.24 andthe gender ratio is M/F ≈ 7/1. Out of 61 tumors, the most common
tumor location is bilateral bladder 30.7%, mostly one tumor (26/38). Featured images: mean size 23.47 ± 14.09 mm, max size 68mm, min size
7 mm; most frequently found polype-shaped tumor 25/38 patients (65.8%). According to the assessment of MRI results with T2W, DCE and DWI distinguishing T staging, tumors in T1 or lower 30/38 patients (78.9%) and T2 or higher 8/38 patients (21,1%, in which 4 patients in T2, one in T3 and 3 in T4). There is no correlation between the number of tumors and T staging (p>0.05). There is a strong correlation between the shape of tumors and T staging (p<0.001). When combining T2W with DCE, the sensitivity,
specificity and overall accuracy of two observers for differentiating Tis to T1 tumor from T2 to T4 tumors were 79.3 %, 100% and 84.2% respectively. When using all three image types together (T2W, DCE and DWI) to assess T staging, the sensitivity rose up to 96.5%, specificity 66.7%, overall accuracy 89.5% and PPV 90.3%. The Cohen’s Kappa score of 0.685 had a good correlation between MRI results and histopathology in distinguishing T-staging of bladder cancer (p<0.001). In addition, a total 36 patients had urothelial carcinoma, ADC values of 29/36 patients at T1 or lower were 1.138 ×10–3mm2/s and 7/36 patients at T2 or higher were 0.79 × 10–3mm2/s, and this difference of ADC was significant between Grade 1 and Grade
3. The total of 29/38 patients (76.3%) underwent TUR and deep muscle biopsy was performed at the base tumor, 9/38 patients underwent radical
cysectomy or chemotherapy before surgery.

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References

TÀI LIỆU THAM KHẢO
1. Takeuchi M., Sasaki S., Ito M., et al. (2009). Urinary Bladder Cancer: Diffusion-weighted MR Imaging— Accuracy for Diagnosing T Stage and Estimating Histologic Grade. Radiology, 251(1), 112–121.
2. Verma S., Rajesh A., Prasad S.R., et al. (2012). Urinary Bladder Cancer: Role of MR Imaging. RadioGraphics, 32(2), 371–387.
3. Takeuchi M., Sasaki S., Naiki T., et al. (2013). MR imaging of urinary bladder cancer for T-staging: A review and a pictorial essay of diffusion-weighted imaging: DWI of Urinary Bladder Cancer Staging. J Magn Reson Imaging, 38(6), 1299–1309.
4. Edge S.B. and Cancer A.J.C. on (2010), AJCC cancer staging handbook: from the AJCC cancer staging manual, Springer New York.
5. Cancer Statistics, 2006 - Jemal - 2006 - CA: A Cancer Journal for Clinicians - Wiley Online Library. , accessed: 07/12/2018.
6. Lê Thanh Dũng (2003). Nghiên cứu giá trị của chụp cắt lớp vi tính trong chẩn đoán u bàng quang. Luận văn tốt nghiệp nội trú(Đại học Y khoa Hà Nội).
7. Dobruch J., Daneshmand S., Fisch M., et al. (2016). Gender and bladder cancer: a collaborative review of etiology, biology, and outcomes. Eur Urol, 69(2), 300–310.
8. Lê Minh Hoàn Nghiên cứu giá trị của chụp cắt lớp vi tính 64 dãy đầu dò trong ung thư bàng quang. Luận văn thạc sỹ y khoa.Đại học Y khoa Hà Nội.
9. Phạm Văn Yến Nghiên cứu đặc điểm lâm sàng, cận lâm sàng mô bệnh học của ung thư bàng quang và kết quả sớm của phẫu thuật cắt bàng quang toàn bộ. Luận Văn bác sỹ chuyên khoa cấp II.Đại học Y khoa Hà Nội.
10. Neoplasms of the Urinary Bladder: Radiologic-Pathologic Correlation | RadioGraphics. , accessed: 07/11/2018.
11. SCATTONI V., RIGATTI P., COBELLI F.D., et al. DYNAMIC GADOLINIUM-ENHANCED MAGNETIC RESONANCE IMAGING IN STAGING OF SUPERFICIAL BLADDER CANCER. 6.
12. Hafeez S. and Huddart R. (2013). Advances in bladder cancer imaging. BMC Med, 11(1), 104.
13. Green D.A., Durand M., Gumpeni N., et al. (2012). Role of magnetic resonance imaging in bladder cancer: current status and emerging techniques: MRI IN BLADDER CANCER: STATUS AND EMERGING TECHNIQUES. BJU Int, 110(10), 1463–1470.
14. Catalina WJ (1992). Bladder cancer. Campbell. Urology.... - Google Scholar. , accessed: 07/12/2018.
15. Tritschler S., Mosler C., Straub J., et al. (2012). Staging of muscle-invasive bladder cancer: can computerized tomography help us to decide on local treatment?. World J Urol, 30(6), 827–831.
16. Tekes A., Kamel I., Imam K., et al. (2005). Dynamic MRI of bladder cancer: evaluation of staging accuracy. Am J Roentgenol, 184(1), 121–127.
17. Saito W., Amanuma M., Tanaka J., et al. (2000). Histopathological analysis of a bladder cancer stalk observed
on MRI. Magn Reson Imaging, 18(4), 411–415.