To that effect, in this study, the authors aim to assess of 3T mp MRI with DWI to predict tumor stage and grade. This was a prospective study over 1.5 years, in which 40 patients were enrolled. They were all imaged on a 3T MRI with T1W, T2W and DWI at 4 b-levels (0, 500, 1000, 1500). This was then followed with standard TURBT or radical cystectomy within 20 days of MRI. MRI’s were analyzed by two expert radiologists independently and were blinded to histopathology. They identified 7 indicators of MIBC, 2 of which had never previously been described
There were 90 evaluable tumors in 40 patients; 23 had single tumor. On univariate analysis, each of the seven features was significantly associated with MIBC on final pathology.
- Strongest association with Absent stalk or distorted stalk with high b-value: AUC 0.87, Sens 87.5%, Diagnostic accuracy 94.5%
- A cutoff ADC of 0.841x10-3 could differentiate high grade from low grade tumors (sens 82.8%, spec 81.8%)
1) On patients who underwent TUR – no re-TUR was done to confirm that they weren’t under staged?
2) What is the utility and predictive value of TURBT +/- urine markers? How does it compare to MRI?
3) With MRI, you will never have pathology. Ultimately pathology will be required?
4) What was the indication for cystectomy in those patients? Had they had prior resection?
Ultimately, cost and accessibility to MR may limit the value of this, similar to the story with prostate cancer and TRUS biopsies.
Presented by: Amlesh Seth
Affiliation: AIMS, New Delhi, India
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal