OJRad  Vol.4 No.2 , June 2014
MRI of the Bladder in Patients Suspected of Bladder Tumors
Abstract: Objective: To prospectively evaluate the use of MRI for the detecting of bladder tumors and the T- stage using T2W, T1W and diffusion-weighted images (DWI). Material and methods: Twenty-eight consecutive patients (21 men, 7 women; age range, 20 - 82 years; mean age, 62.8 years) suspected of bladder tumors underwent MRI, flexible cystoscopy and transurethral resection (TURB). The presence of bladder tumor was confirmed by histopathology in 21 patients; 18 patients had pTa, one pT1 and two pT2. The images were reviewed by two uroradiologists. They assigned the presence of a bladder tumor and whether the tumor was non-muscle invasive (Ta and T1) or muscle- invasive (T2, T3 or T4). Results: Compared to the histopathological results, the accuracy for identifying a bladder tumor was 60.7% and 53.7% for reviewer A and B, respectively. The sensitivity and specificity were 66.7%/61.9% and 57.1%/42.9%. Positive predictive values were 82.6%/ 76.5%. The overall staging was correct in 47.6%/52.5%, but improved on stage-by-stage up to 50%/66.7%. The agreement between the reviewers was moderate in the detecting, staging and location of the tumor (Kappa = 0.47 - 0.57). Conclusion: A simple MRI using no contrast media, but DWI, cannot replace flexible cystoscopy in the detection of new or recurrent bladder tumors.
Cite this paper: Gandrup, K. , Nordling, J. and Thomsen, H. (2014) MRI of the Bladder in Patients Suspected of Bladder Tumors. Open Journal of Radiology, 4, 207-214. doi: 10.4236/ojrad.2014.42028.

[1]   Siegel, R., Ma, J., Zou, Z. and Jemal, A. (2014) Cancer Statistics 2014. CA: A Cancer Journal for Clinicians, 64, 9-29.

[2]   Babjuk, M., Oosterlinck, W., Sylvester, R., Kaasinen, E., Böhle, A., Palou-Redorta, J., et al. (2011) EAU Guidelines on Non-Muscle-Invasive Urothelial Carcinoma of the Bladder, the 2011 Update. European Urology, 59, 997-1008.

[3]   Stenzl, A., Cowan, N.C., De Santis, M., Kuczyk, M.A., Merseburger, A.S., Ribal, M.J., et al. (2011) Treatment of Muscle-Invasive and Metastatic Bladder Cancer: Update of the EAU Guidelines. European Urology, 59, 1009-1018.

[4]   Jacobs, B.L., Lee, C.T. and Montie, J.E. (2010) Bladder Cancer in 2010: How Far Have We Come? CA: A Cancer Journal for Clinicians, 60, 244-272.

[5]   Zhang, J., Gerst, S., Lefkowitz, R.A. and Bach, A. (2007) Imaging of Bladder Cancer. Radiologic Clinics of North America, 45, 183-205.

[6]   Matsuki, M., Inada, Y., Tatsugami, F., Tanikake, M., Narabayashi, I. and Katsuoka, Y. (2007) Diffusion-Weighted MR Imaging for Urinary Bladder Carcinoma: Initial Results. European Urology, 17, 201-204.

[7]   Kobayashi, S., Koga, F. and Yoshida, S., et al. (2011) Diagnostic Performance of Diffusion-Weighted Magnetic Resonance Imaging in Bladder Cancer: Potential Utility of Apparent Diffusion Coefficient Values as a Biomarker to Predict Clinical Aggressiveness. European Urology, 21, 2178-2186.

[8]   Avcu, S., Koseoglu, M.N., Ceylan, K., Bulut, M.D., Dbulutand, M. and Unal, O. (2011) The Value of Diffusion-Weighted MRI in the Diagnosis of Malignant and Benign Urinary Bladder Lesions. The British Journal of Radiology, 84, 875-882.

[9]   Wu, L.-M., Chen, X.-X., Xu, J.-R., Zhang, X.-F., Suo, S.-T., Yao, Q.-Y., et al. (2013) Clinical Value of T2-Weighted Imaging Combined with Diffusion-Weighted Imaging in Preoperative T Staging of Urinary Bladder Cancer: A Large-Scale, Multiobserver Prospective Study on 3.0-T MRI. Academic Radiology, 20, 939-946.

[10]   Abou-El-Ghar, M. and El-Assmy, A. (2009) Bladder Cancer: Diagnosis with Diffusion-weighted MR Imaging in Patients with Gross Hematuria. Radiology, 251, 415-421.

[11]   El-Assmy, A., Abou-El-Ghar, M.E., Mosbah, A., El-Nahas, A.R., Refaie, H.F., Hekal, I.A., et al. (2009) Bladder Tumour Staging: Comparison of Diffusion-and T2-Weighted MR Imaging. European Urology, 19, 1575-1581.

[12]   El-Assmy, A., Abou-El-Ghar, M.E., Refaie, H.F. and El-Diasty, T. (2008) Diffusion-Weighted MR Imaging in Diagnosis of Superficial and Invasive Urinary Bladder Carcinoma: A Preliminary Prospective Study. Scientific World Journal, 8, 364-370.

[13]   Tekes, A., Kamel, I., Imam, K., Szarf, G., Schoenberg, M., Nasir, K., et al. (2005) Dynamic MRI of Bladder Cancer: Evaluation of Staging Accuracy. American Journal of Roentgenology, 184, 121-127.

[14]   Takeuchi, M., Sasaki, S., Ito, M., Okada, S., Takahashi, S., Kawai, T., et al. (2009) Urinary Bladder Cancer: Diffusion-weighted MR Imaging—Accuracy for Diagnosing T Stage and Estimating Histologic Grade. Radiology, 251, 112-121.

[15]   Watanabe, H., Kanematsu, M., Kondo, H., Goshima, S., Tsuge, Y., Onozuka, M., et al. (2009) Preoperative T Staging of Urinary Bladder Cancer: Does Diffusion-Weighted MRI Have Supplementary Value? American Journal of Roentgenology, 192, 1361-1366.

[16]   Eble, J., Sauter, G., Epstein, J. and Sesterhenn, I. (2004) Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press, Lyon.

[17]   Sobin, L.H., Gospodarowicz, M.K. and Wittekind, C. (2009) International Union against Cancer (UICC): TNM Classification of Malignant Tumours. 7th Edition, Wiley-Blackwell, Chicester.

[18]   Wein, A. (2010) Non-Muscle-Invasive Bladder Cancer (Ta, T1, and CIS). In: Kavoussi, L., Novick, A., Partin, A. and Peters, C., Eds., Campbell-Walsh Urology, Elsevier Saunders, Philadelphia, 2335-2354.

[19]   Thoeny, H.C., Forstner, R. and De Keyzer, F. (2012) Genitourinary Applications of Diffusion-Weighted MR Imaging in the Pelvis. Radiology, 263, 326-342.

[20]   Barentsz, J.O., Jager, G.J., Witjes, J.A. and Ruijs, J.H. (1996) Primary Staging of Urinary Bladder Carcinoma: The Role of MRI and a Comparison with CT. European Radiology, 6, 129-133.

[21]   El-Assmy, A., Abou-El-Ghar, M.E., Refaie, H.F., Mosbah, A. and El-Diasty, T. (2012) Diffusion-Weighted Magnetic Resonance Imaging in Follow-Up of Superficial Urinary Bladder Carcinoma after Transurethral Resection: Initial Experience. BJU International, 110, E622-E627.

[22]   Dobson, M.J., Carrington, B.M., Collins, C.D., Ryder, W.D., Read, G., Hutchinson, C.E., et al. (2001) The Assessment of Irradiated Bladder Carcinoma Using Dynamic Contrast-Enhanced MR Imaging. Clinical Radiology, 56, 94-98.

[23]   Purysko, A.S., Leão Filho, H.M. and Herts, B.R. (2012) Radiologic Imaging of Patients with Bladder Cancer. Seminars in Oncology, 39, 543-558.