title: Bladder tumor staging: comparison of contrast-enhanced and gray-scale ultrasound.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.
  
  
  METHODS
  Conventional and contrast-enhanced sonography were performed on 34 consecutively registered patients with bladder tumors. All examinations were reviewed by two independent sonologists. At gray-scale sonography, interruption of the hyperechoic bladder wall was considered the main diagnostic criterion for differentiating superficial and infiltrating tumors. At contrast-enhanced sonography, a tumor was considered superficial when the hypoenhancing muscle layer of the bladder wall was intact; disruption of the muscle layer by enhancing tumor tissue was considered diagnostic of infiltration. A level of confidence in the diagnosis of tumor infiltration of the muscle layer was assigned on a 5-degree scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle infiltration by tumor at both conventional and contrast-enhanced sonography. Histologic diagnosis was obtained for all patients.
  
  
  RESULTS
  Final pathologic staging revealed 25 superficial tumors (Ta-T1 disease) and nine muscle-infiltrating tumors (>T1). Conventional sonography depicted five of nine muscle-infiltrating tumors, and contrast-enhanced sonography depicted all nine. The diagnostic performance of contrast-enhanced sonography approached that of the reference standard (area under the receiver operating characteristic curve, 0.996), but the diagnostic performance of gray-scale ultrasound was worse (area under curve, 0.613).
  
  
  CONCLUSIONS
  Our study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.
authors.affiliation: Dipartimento di Biotecnologie mediche e Medicina legale, Sezione di scienze radiologiche, Università degli Studi di Palermo, Via del Vespro 127, Palermo 90127, Italy. carusogi@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caruso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Salvaggio
authors.forename: Antonella
authors.initials: A
authors.lastname: Campisi
authors.forename: Darwin
authors.initials: D
authors.lastname: Melloni
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.forename: Michele
authors.initials: M
authors.lastname: Bertolotto
authors.forename: Roberto
authors.initials: R
authors.lastname: Lagalla
mesh_terms: D000368:Aged; D003287:Contrast Media; D003558:Cystoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012372:ROC Curve; D014463:Ultrasonography; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D003287:Contrast Media