Diffusion weighted magnetic resonance imaging in bladder cancer, is it time to replace biopsy?

Rima S Al Johi, Gehan S Seifeldein, Ahmed M Moeen, Noha A Aboulhagag, Ehab M Moussa, Diaa A Hameed, Hisham M Imam, Rima S Al Johi, Gehan S Seifeldein, Ahmed M Moeen, Noha A Aboulhagag, Ehab M Moussa, Diaa A Hameed, Hisham M Imam

Abstract

Introduction: To assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC).

Material and methods: 102 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm2 were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated.

Results: The cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10-3 mm2/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (P = 0.045) but not between G1 and G2 (p = 0.066). Staging accuracy for differentiation between invasive and non-invasive lesions was nearly the same for all MRI data sets. For differentiation between organ confined (pT1-pT2) and non-organ confined lesions (pT3-pT4), staging accuracy was better in T2WI plus DWI (83%) as compared to DWI alone (77%) or T2WI alone (75%).

Conclusions: Adding DWI and the ADC value to T2WI improve the accuracy of MRI in BC detection and staging. However, at this time point, MRI cannot replace transurethral resection (TUR) biopsy or distinguish sharply between all different histologic grades and cell types.

Keywords: bladder cancer; diffusion magnetic resonance imaging; neoplasm grading; neoplasm staging.

Figures

Figure 1
Figure 1
A 50-years old woman with squamous cell carcinoma, GII, pT3. (A) T2-weighted axial imaging shows a tumor with intermediate signal intensity arising from the left lateral wall of the bladder (curved arrow). (B) Diffusion-weighted image (b = 1000 s/mm2) depicts the tumor as having hyperintense signal intensity with an irregular outline (curved arrow). (C) Apparent diffusion coefficient map: 0.9 x 10-3 mm2/s (D) Moderately differentiated Squamous cell carcinoma infiltrating the muscularis propria of the urinary bladder, H&E, x200.
Figure 2
Figure 2
A 43-year-old man with bilharzial cystitis. (A) T2-weighted imaging shows a tumor with intermediate signal intensity on the left posterolateral side of the bladder. (B) Diffusion-weighted image of the tumor shows restricted diffusion. (C) Apparent diffusion coefficient map: 1.4 x 10-3 mm2/s. (D) Bilharzial cystitis showing multiple bilharzial ova (arrows) in the lamina propria of the urinary bladder surrounded by chronic inflammatory cells, H&E, x200.
Figure 3
Figure 3
A flow chart showing the procedures done to the patients.

References

    1. Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in Egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014:437971..
    1. Green DA, Rink M, Hansen J, et al. Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy. BJU Int. 2013;111:404–411.
    1. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet. 2009;374:239–249.
    1. Lee M, Shin SJ, Oh YT, et al. Non-contrast magnetic resonance imaging for bladder cancer: fused high b value diffusion-weighted imaging and T2-weighted imaging helps evaluate depth of invasion. Eur Radiol. 2017;27:3752–3758.
    1. Helenius M, Brekkan E, Dahlman P, Lönnemark M, Magnusson A. Bladder cancer detection in patients with gross haematuria: Computed tomography urography with enhancement-triggered scan versus flexible cystoscopy. Scand J Urol. 2015;49:377–381.
    1. Gandrup KL, Løgager VB, Bretlau T, Nordling J, Thomsen HS. Diagnosis of bladder tumours in patients with macroscopic haematuria: a prospective comparison of split-bolus computed tomography urography, magnetic resonance urography and flexible cystoscopy. Scand J Urol. 2015;49:224–229.
    1. Thoeny HC, Forstner R, De Keyzer F. Genitourinary applications of diffusion- weighted MR imaging in the pelvis. Radiology. 2012;263:326–342.
    1. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007;188:1622–1635.
    1. Afaq A, Koh DM, Padhani A, van As N, Sohaib SA. Clinical utility of diffusion-eighted magnetic resonance imaging in prostate cancer. BJU Int. 2011;108:1716–1722.
    1. Kobayashi S, Koga F, Yoshida S. 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.
    1. Abou-El-Ghar ME, El-Assmy A, Refaie HF, El-Diasty T. Bladder cancer: diagnosis with diffusionweighted MR imaging in patients with gross hematuria. Radiology. 2009;251:415–421.
    1. 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.
    1. Takeuchi M, Sasaki S, Ito M, et al. Urinary Bladder cancer: diffusion weighted MR imaging-accuracy for diagnosing T stage and estimating histologic grade. Radiology. 2009;251:112–121.
    1. Barentsz JO, Engelbrecht MR, Witjes JA, de la Rosette JJ, van der Graaf M. MR imaging of the male pelvis. Eur Radiol. 1999;9:1722–1736.
    1. Dorfman RE, Alpern MB, Gross BH, Sandler MA. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology. 1991;180:319–322..
    1. Narumi Y, Kadota T, Inoue E, et al. Bladder wall morphology: in vitro MR imaging-histopathologic correlation. Radiology. 1993;187:151–155.
    1. Eble JN, Sauter G, Epstein JL, Sesterhenn IA, editors. Pathology and genetics: tumours of the urinary system and male genital organs. Lyon: IARC Press, International Agency for Research on Cancer; World Health Organization classification of tumours; 2004. v 6.s.
    1. Sobin LH, Gospodariwicz MK, Wittekind C. International Union against Cancer. TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell; 2009.
    1. Sherif A, Jonsson MN, Wiklund NP. Treatment of muscle-invasive bladder cancer. Expert Rev Anticancer Ther. 2007;7:1279–1283.
    1. Abdel-Rahman HM, El Fiki IM, Desoky EAE, Elsayed ER, Abd Samad KM. The role of diffusion-weighted magnetic resonance imaging in T staging and grading of urinary bladder cancer. Egypt J Radiol Nucl Med. 2015;46:741–747.
    1. Watanabe H, Kanematsu M, Kondo H, et al. Preoperative T staging of urinary bladder cancer: does diffusion-weighted MRI have supplementary value? AJR. 2009; 192:1361–1366.
    1. Avcu S, Koseoglu MN, Ceylan K, Bulut MD, Unal O. The value of diffusion- weighted MRI in the diagnosis of malignant and benign urinary bladder lesions. Br J Radiol. 2011;84:875–882.
    1. Ceylan K, Taken K, Gecit T, et al. Comparison of cystoscopy with diffusion- weighted magnetic resonance images used in the diagnosis and follow-up of patients with bladder tumors. Asian Pac J Cancer Prev. 2010;11:1001–1004.
    1. Dağgülli M, Onur MR, Fırdolaş F, Onur R, Kocakoç E, Orhan İ. Role of diffusion MRI and apparent diffusion coefficient measurement in the diagnosis, staging and pathological classification of bladder tumors. Urol Int. 2001;87:346–352.
    1. Yamada Y, Kobayashi S, Isoshima S, Arima K, Sakuma H, Sugimura Y. The usefulness of diffusion weighted magnetic resonance imaging in bladder cancer staging and functional analysis. J Cancer Res Ther. 2014;10:878–882.
    1. Gupta N, Sureka B, Kumar MM, Malik A, Bhushan TB, Mohanty NK. Comparison of dynamic contrast-enhanced and diffusion weighted magnetic resonance image in staging and grading of carcinoma bladder with histopathological correlation. Urol Ann. 2015;7:199–204.
    1. Wang H, Guan J, Guo Y, Guang Z. Estimation of bladder carcinoma histologic grade with diffusion weighted MR imaging. Eur Soc Radiol. 2014;138:409–414.
    1. Sherif MF. The value of diffusion weighted MR imaging in T staging and correlation with histologic grading in urinary bladder cancer. Egypt J Radiol Nucl Med. 2015;46:189–194.
    1. Wu LM, Chen XX, Xu JR, Zhang XF, et al. Clinical value of T2-weighted imaging combined with diffusion-weighted imaging in preoperative T staging of urinary bladder cancer: a large-scale, multiobserver prospective study on 3.0-T MRI. Acad Radiol. 2013;20:939–946.
    1. El-Assmy A, Abou-El-Ghar ME, et al. Bladder tumour staging: comparison of diffusion- and T2-weighted MR imaging. Eur Radiol. 2009;19:1575–1581.
    1. Papalia R, Simone G, Grasso R, Augelli R, et al. Diffusion-weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases. BJU Int. 2012;109:1031–1036.
    1. Lin WC, Chen J-H. Pitfalls and limitations of diffusion-weighted magnetic resonance imaging in the diagnosis of urinary bladder cancer. Transl Oncol. 2015;8:217–230.

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