Advertisement

Utility of diffusion-weighted MRI in the diagnosis of bladder carcinoma

      Abstract

      Background

      The purposes of our study were to investigate the feasibility of diffusion-weighted imaging in the detection of malignant bladder tumors, with comparison to the high-resolution thin-section fast spin-echo (FSE) T2-weighted MRI, and also to compare the apparent diffusion coefficient (ADC) values of the bladder tumors with the surrounding structures.

      Material and Methods

      Fifty-three consecutive patients consisting of 44 males and 9 females who presented with a bladder mass were prospectively enrolled in this study. Mean age was 62.53±12.03 (age range, 33–86 years). These patients were evaluated by high-resolution thin-section FSE T2-weighted and diffusion-weighted MRI for the detection of bladder masses. Following MRI, within 2 weeks, all patients were subjected to either surgery or cystoscopic biopsy, and the obtained histopathological proofs were used as the reference standard. Furthermore, ADC values of the bladder tumors, urine, the normal bladder wall, the central and peripheral zones of the prostate, the seminal vesicule, and the uterus outer myometrium were also calculated. ADC values of the bladder carcinomas and the related surrounding structures were compared as to whether a statistically significant difference was present or not.

      Results

      In a total of 47 patients, consisting of 39 males and 8 females, bladder carcinomas were clearly shown as having conspicuous high and intermediate signal intensity masses, relative to the surrounding structures on diffusion-weighted and T2-weighted images, respectively. An 89% sensitivity and a 100% positive predictive value were obtained for both FSE T2-weighted and diffusion-weighted MRI in the diagnosis of bladder carcinoma. Mean ADC values and standard deviations of the bladder tumors and the surrounding structures were as follows: bladder carcinomas (n=47): 1.28±0.31, normal bladder wall (n=47): 1.98±0.41, urine (n=47): 3.12±0.24, seminal vesicle (n=39): 1.82±0.33, peripheral zone of prostate (n=39): 1.80±0.29, central zone of prostate (n=39): 1.55±0.33, and uterus outer myometrium (n=8): 1.53±0.19. It can be clearly seen that the mean ADC values of the bladder carcinomas were significantly lower than the surrounding structures (P<.05).

      Conclusıon

      High-resolution thin-section FSE T2 and diffusion-weighted MRI show high diagnostic performance and are comparable in the detection of bladder tumors. Diffusion-weighted MRI provides high quality images of the malignant bladder tumors against a suppressed background signal. Diffusion-weighted MRI using ADC measurements may be useful in the evaluation of tumor invasion to the adjacent organs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wong-You-Cheong JJ
        • Woodward PJ
        • Manning MA
        • Sesterhenn IA
        From the archives of the AFIP: neoplasms of the urinary bladder - radiologic - pathologic correlation.
        Radiographics. 2006; 26: 553-580
        • Zhang J
        • Gerst S
        • Lefkowitz RA
        • Bach A
        Imaging of bladder cancer.
        Radiol Clin North Am. 2007; 45: 183-205
        • Renken NS
        • Krestin GP
        Magnetic resonance imaging of the kidney.
        Semin Ultrasound CT MR. 2005; 26: 153-161
        • Padhani AR
        • Liu G
        • Koh DM
        • Chenevert TL
        • Thoeney HC
        • Takahara T
        • et al.
        Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations.
        Neoplasia. 2009; 11: 102-125
        • Thoeny HC
        • De Keyzer F
        • Oyen RH
        • Peeters RR
        Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience.
        Radiology. 2005; 235: 911-917
        • Sato C
        • Naganawa S
        • Nakamura T
        • Kumada H
        • Miura S
        • Takizawa O
        • et al.
        Differentiation of non-cancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate.
        J Magn Reson Imaging. 2005; 21: 258-262
        • Yoshida S
        • Masuda H
        • Ishii C
        • Saito K
        • Kawakami S
        • Kihara K
        Initial experience of functional imaging of upper urinary tract neoplasm by diffusion-weighted magnetic resonance imaging.
        Int J Urol. 2008; 15: 140-143
        • Nikken JJ
        • Krestin GP
        MRI of the kidney – state of the art.
        Eur Radiol. 2007; 17: 2780-2793
        • Matsuki M
        • Inada Y
        • Tatsugami F
        • Tanikake M
        • Narabayashi I
        • Katsuoka Y
        Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results.
        Eur Radiol. 2007; 17: 201-204
        • El-Assmy A
        • Abou-El-Ghar ME
        • Refaie HF
        • El-Diasty T
        Diffusion-weighted MR imaging in diagnosis of superficial and invasive urinary bladder carcinoma: a preliminary prospective study.
        Scientific World J Urol. 2008; 8: 364-370
        • Abou-El-Ghar ME
        • El-Assmy A
        • Refaie HF
        • El-Diasty T
        Bladder cancer: diagnosis with diffusion-weighted MR imaging in patients with gross hematuria1.
        Radiology. 2009; 251: 415-421
        • Kobayashi S
        • Koga F
        • Yoshida S
        • Masuda H
        • Ishii C
        • Tanaka H
        • et al.
        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.
        Eur Radiol. 2011; 21: 2178-2186
        • Watanabe H
        • Kanematsu M
        • Kondo H
        • Goshima S
        • Tsuge Y
        • Onozuka M
        • et al.
        Preoperative T staging of bladder cancer: does diffusion weighted MRI have supplementary value ?.
        AJR. 2009; 192: 1361-1366
        • Kilickesmez O
        • Cimilli T
        • Inci E
        • Kayhan A
        • Bayramoglu S
        • Tasdelen N
        • et al.
        Diffusion weighted MRI of urinary bladder and prostate cancers.
        Diagn Interven Radiol. 2009; 15: 104-110