Bladder cancer: diagnosis with diffusion-weighted MR imaging in patients with gross hematuria.
OBJECTIVE
To prospectively evaluate the usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging for the detection of bladder neoplasms in patients with gross hematuria of lower urinary tract origin.


METHODS
The study protocol received institutional ethical committee approval, and informed consent was obtained. Between April 2007 and March 2008, 130 consecutive patients with gross hematuria whose upper urinary tract had a normal appearance at ultrasonographic examination were prospectively enrolled. Mean age was 59.4 years (range, 45-75 years). All patients were evaluated by using T2-weighted high-spatial-resolution MR imaging of the urinary bladder, followed by DW MR imaging. Two radiologists independently interpreted the T2-weighted and DW images, and discrepancies were resolved by consensus. Agreement was evaluated by using the kappa statistic. All patients underwent conventional cystoscopy. With cystoscopy and the final histopathologic findings as the reference standards, a comparison with imaging findings was performed by using the McNemar test.


RESULTS
The consensus diagnostic performance of DW MR imaging for identification of bladder tumors was: sensitivity, 98.1% (104 of 106); specificity, 92.3% (24 of 26); PPV, 100% (104 of 104); negative predictive value, 92.3% (24 of 26); and accuracy, 97.0% (128 of 132). Two cases were falsely negative on T2-weighted MR images but were correctly diagnosed by using DW MR images. The agreement between DW MR imaging results and cystoscopic findings was excellent (kappa = 0.94) for identification of bladder neoplasm. DW MR imaging had a sensitivity and PPV of 98.5% (128 of 130) and 100% (128 of 128), respectively, for determining the cause of hematuria.


CONCLUSIONS
DW MR imaging is a highly reliable imaging approach for identification of bladder tumors in patients with gross hematuria.
Abou-El-Ghar
Mohamed E
ME
Departments of Radiology, and Urology, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt. a_assmy@yahoo.com
El-Assmy
Ahmed
A
Refaie
Huda F
HF
El-Diasty
Tarek
T
D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000175:diagnosis*