Bladder Tumor Staging: Comparison of Contrast-Enhanced and Gray-Scale Ultrasound

• Published in: American journal of roentgenology (1976) Vol. 194; no. 1; pp. 151 - 156
• Main Authors: Caruso, Giuseppe, Salvaggio, Giuseppe, Campisi, Antonella, Melloni, Darwin, Midiri, Massimo, Bertolotto, Michele, Lagalla, Roberto
• Format: Journal Article
• Language: English
• Published: Reston, VA Am Roentgen Ray Soc 01.01.2010; American Roentgen Ray Society
• Subjects: Aged; Biological and medical sciences; Contrast Media; Cystoscopy; Diagnosis, Differential; Female; Humans; Image Interpretation, Computer-Assisted; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Nephrology. Urinary tract diseases; ROC Curve; Tumors of the urinary system; Ultrasonography; Urinary Bladder Neoplasms - diagnostic imaging; Urinary Bladder Neoplasms - pathology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Sonography; Human; Histological grading; Urinary system disease; Tumor staging; Urinary tract disease; Bladder tumor; Gray scale; Echography; Adult; Bladder disease; Diagnosis; Technique; Comparative study; Contrast media
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.09.2741

The purpose of this study was to evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder. Conventional and contrast-enhanced sonography were performed on 34 consecutively registered patients with bladder tumors. All examinations were reviewed by two independent sonologists. At gray-scale sonography, interruption of the hyperechoic bladder wall was considered the main diagnostic criterion for differentiating superficial and infiltrating tumors. At contrast-enhanced sonography, a tumor was considered superficial when the hypoenhancing muscle layer of the bladder wall was intact; disruption of the muscle layer by enhancing tumor tissue was considered diagnostic of infiltration. A level of confidence in the diagnosis of tumor infiltration of the muscle layer was assigned on a 5-degree scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle infiltration by tumor at both conventional and contrast-enhanced sonography. Histologic diagnosis was obtained for all patients. Final pathologic staging revealed 25 superficial tumors (Ta-T1 disease) and nine muscle-infiltrating tumors (>T1). Conventional sonography depicted five of nine muscle-infiltrating tumors, and contrast-enhanced sonography depicted all nine. The diagnostic performance of contrast-enhanced sonography approached that of the reference standard (area under the receiver operating characteristic curve, 0.996), but the diagnostic performance of gray-scale ultrasound was worse (area under curve, 0.613). Our study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.