Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging

• Published in: Radiology Vol. 201; no. 1; p. 185
• Main Authors: Barentsz, J O, Jager, G J, van Vierzen, P B, Witjes, J A, Strijk, S P, Peters, H, Karssemeijer, N, Ruijs, S H
• Format: Journal Article
• Language: English
• Published: United States 01.10.1996
• Subjects: Biopsy; Carcinoma, Transitional Cell - pathology; Contrast Media; Drug Combinations; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Lymphatic Metastasis; Magnetic Resonance Imaging - methods; Male; Meglumine; Middle Aged; Neoplasm Staging; Organometallic Compounds; Pentetic Acid - analogs & derivatives; Prospective Studies; Sensitivity and Specificity; Urinary Bladder - pathology; Urinary Bladder Neoplasms - pathology
• ISSN: 0033-8419
• DOI: 10.1148/radiology.201.1.8816542

To evaluate contrast enhancement patterns of urinary bladder cancer and surrounding structures and to evaluate a fast dynamic first-pass magnetic resonance (MR) imaging technique in tumor and node staging and in differentiation of urinary bladder cancer from postbiopsy effects. Sixty-one consecutive patients with histologically proved urinary bladder cancer were referred to undergo unenhanced and dynamic MR imaging 1-4 weeks after transurethral resection or biopsy. Subtraction and time (to beginning of enhancement) images were acquired. Results with unenhanced T1- and T2-weighted images were compared with those obtained with the unenhanced images plus dynamic contrast material-enhanced single-section turbo fast low-angle shot (FLASH) images. Urinary bladder cancer started to enhance 6.5 seconds +/- 3.5 (standard deviation) after the beginning of arterial enhancement, which was 4 seconds earlier than most other structures (postbiopsy tissue, 13.6 seconds +/- 4.2). In differentiation of postbiopsy tissue from malignancy on the basis of the beginning of enhancement depicted on time and subtracted images, accuracy improved from 79% to 90% (P < .02) and specificity improved from 33% to 92% (not significant). Overall, tumor staging accuracy improved significantly from 67% to 84% (P < .01) by adding the turbo FLASH images. Fast dynamic first-pass MR imaging, with at least one image acquired every 2 seconds, improved delineation of urinary bladder cancer, tumor staging, and detection of metastases.