To assess the clinical applicability of local tumor staging in urinary bladder cancer (BC) with preoperative multiparametric MRI (mpMRI) using the five-point Vesical Imaging-Reporting and Data System (VI-RADS) scoring system and to compare it to dual-phase contrast-enhanced computed tomography (CECT).
33 patients with primary untreated bladder cancer underwent CECT followed by preoperative multiparametric 3.0 T MRI between July 2019 and August 2020 and were enrolled in this retrospective study. Two radiologists initially performed staging on the CECT image data sets and - blinded to CT results - on subsequent mpMRI. BCs were staged according to the VI-RADS scoring system. Postoperative pathology was correlated to the VI-RADS score and the CECT results. The performance of VI-RADS in determining detrusor muscle invasion was analyzed using a receiver operating characteristic curve. Based on the histopathology, sensitivity, specificity and accuracy for muscle invasiveness between both image modalities were compared using the Chi square test.
A total of 33 patients (29 male, median age 70 years, IQR: 59-81 years) were included. 10 tumors were categorized as non-muscle invasive (30%) and 23 as muscle invasive BC (70%) in final histology. Tumor stages were correctly assigned as being either muscle invasive or non-muscle invasive on both CECT and mpMRI with regard to both early and late stages of BC (Ta-Tis and T3a-T4b). T-stages bordering the histopathologic limits of muscle invasiveness (T1-T2a-b) resulted in overestimation of muscle invasion in 43% of cases (VI-RADS 3-4) for the mpMRI image data sets and in an underestimation of muscle invasion in up to 55.5% of cases analysing the CECT data. Sensitivity and specificity for the determination of muscle invasion in CECT and mpMRI were 80%/80% and 74%/61% for Radiologist#1 and 70%/90% and 83%/70% for Radiologist#2, respectively.
There are advantages and disadvantages of both CECT and mpMRI when used in the clinical assessment of BC muscular tumor invasion. In borderline cases, only the combination of cross-sectional imaging and histopathological staging may help in making the optimal treatment decisions.
European journal of radiology. 2021 Nov 20 [Epub ahead of print]
Florian Hagen, Valentina Norz, Wolfgang M Thaiss, Antonia Mair, Steffen Rausch, Jens Bedke, Konstantin Nikolaou, Arnulf Stenzl, Stephan Kruck, Tobias Hepp, Sascha Kaufmann, Arne Estler
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany., Department of Urology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany., Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; Department of Nuclear Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany. Electronic address: ., Clinic of Urology, Siloah St. Trudpert Klinikum, Wilferdinger Str. 67, 75179 Pforzheim, Germany., Max Planck Institute for Intelligent Systems, Empirical Inference Department, Max-Planck-Ring 4, 72076 Tübingen, Germany., Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany; Diagnostic and Interventional Radiology, Siloah St. Trudpert Klinikum, Wilferdinger Str. 67, 75179 Pforzheim, Germany.