Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Staging of Bladder Cancer

Abstract

Introduction: Dynamic Contrast Enhanced (DCE)-Magnetic Resonance Imaging (MRI) is a useful technique in which rapid enhancement of tumour by uptake of the contrast agent compared to bladder wall. Aim: To evaluate the accuracy of dynamic gadolinium-enhanced MRI in staging of bladder cancer through differentiating superficial tumours from invasive tumours and organ-confined tumours from non-organ-confined tumours. In addition, the benefits of DCE-MRI in diagnosis of tumour progression steps were investigated. Materials and Methods: This was a quasi-experimental study in which 45 patients (95.55 men and 4.45 women) were enrolled. Patients with confirmed transitional cell carcinoma by histopathology findings were imaged using 1.5 Tesla MRI systems. Pathology results were considered as the standard reference. Tumour stage was determined by imaging findings and compared with pathologic findings after radical cystectomy. Data were analysed by SPSS version 16 and the level of significance in all tests was considered p<0.001. Results: The most common stage that was seen in pathology and MRI findings was T3b. Kappa agreement coefficient between MRI and pathology was 0.7 (p<0.001). The accuracy of MRI in differentiating superficial tumours (<= T1) from invasive tumours (<= T2a), and organ-confined tumours (<= T2b) from non-organconfined tumours (<= T3b) was 0.97 and 0.84, respectively. The overall accuracy of MRI was 0.77 (p<0.001). Totally, 10 cases of disagreement between MRI and pathological staging were found, eight (80) of which were overestimated and two cases (20) underestimated. MRI detection rate was 0 in stage Ta, 100 in stage T1, 66.7 in stage T2, 86.7 in stage T3, and 100 in stage T4. The sensitivity and specificity of MRI in differentiating superficial tumours from invasive tumours were 0.97 and 1, respectively, and in differentiating organ-confined tumours from non-organ-confined tumours were 0.94 and 0.77, respectively. The Spearman's correlation coefficient between the signal enhancement slope of time-intensity curves and tumour stages was 0.88 (p<0.001). Conclusion: Gadolinium-enhanced MRI is an appropriate and useful modality with a high accuracy in determining the stage of the bladder cancer. In addition, this method shows extension and progression of tumour and tumour invasion depth.