Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK.
To assess the accuracy of magnetic resonance imaging (MRI) in staging bladder cancer and to assess whether dynamic gadolinium-enhanced sequences have any added benefit in staging.
Over a 22 month period, the MRI findings of 100 consecutive patients with histologically proven transitional cell carcinoma (TCC) of the bladder were reviewed. The T stage was assessed independently on T2-weighted imaging alone and in combination with gadolinium-enhanced MRI. The final histological diagnosis was considered the reference standard. Statistical analysis was performed to ascertain stage-by-stage accuracy. Accuracy of MRI in differentiating superficial (≤T1) from invasive (≥T2) and in differentiating organ-confined (≤ T2) from non-organ-confined (≥T3) disease was assessed.
On a stage-by-stage basis, tumours were correctly staged using MRI in 63% of patients (observed agreement=0.63, weighted kappa=0.57). The sensitivity and specificity of MRI to differentiate between superficial (≤ T1) from invasive (≥T2) disease was 78.2 and 93.3%. The observed agreement for this group was 85% (kappa=70%; p<0.0001). The sensitivity and specificity of MRI to differentiate between organ-confined (≤ T2) from non-organ confined (≥T3) disease was 90.5 and 60%. The observed agreement for this group was 89% (kappa=30%; p< 0.01). Gadolinium-enhanced images improved staging in only three patients.
In the present study MRI was found to be a moderately accurate tool in assessing the T stage. Agreement on a stage-by-stage basis was good. Agreement for differentiating between non-invasive versus muscle-invasive disease was good and that for organ-confined versus non-organ-confined disease was fair. Routine use of gadolinium-enhanced images is not routinely required.
Written by:
Rajesh A, Sokhi HK, Fung R, Mulcahy KA, Bankart MJ. Are you the author?
Reference: Clin Radiol. 2011 Sep 14. Epub ahead of print.
doi: 10.1016/j.crad.2011.05.019
PubMed Abstract
PMID: 21924408
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