title: Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Staging of Bladder Cancer.
abstract: BACKGROUND
  Dynamic Contrast Enhanced (DCE)-Magnetic Resonance Imaging (MRI) is a useful technique in which rapid enhancement of tumour by uptake of the contrast agent compared to bladder wall.
  
  
  OBJECTIVE
  To evaluate the accuracy of dynamic gadolinium-enhanced MRI in staging of bladder cancer through differentiating superficial tumours from invasive tumours and organ-confined tumours from non-organ-confined tumours. In addition, the benefits of DCE-MRI in diagnosis of tumour progression steps were investigated.
  
  
  METHODS
  This was a quasi-experimental study in which 45 patients (95.55% men and 4.45% women) were enrolled. Patients with confirmed transitional cell carcinoma by histopathology findings were imaged using 1.5 Tesla MRI systems. Pathology results were considered as the standard reference. Tumour stage was determined by imaging findings and compared with pathologic findings after radical cystectomy. Data were analysed by SPSS version 16 and the level of significance in all tests was considered p<0.001.
  
  
  RESULTS
  The most common stage that was seen in pathology and MRI findings was T3b. Kappa agreement coefficient between MRI and pathology was 0.7 (p<0.001). The accuracy of MRI in differentiating superficial tumours (≤T1) from invasive tumours (≥ T2a), and organ-confined tumours (≤T2b) from non-organ-confined tumours (≥T3b) was 0.97 and 0.84, respectively. The overall accuracy of MRI was 0.77 (p<0.001). Totally, 10 cases of disagreement between MRI and pathological staging were found, eight (80%) of which were overestimated and two cases (20%) underestimated. MRI detection rate was 0% in stage Ta, 100% in stage T1, 66.7% in stage T2, 86.7% in stage T3, and 100% in stage T4. The sensitivity and specificity of MRI in differentiating superficial tumours from invasive tumours were 0.97 and 1, respectively, and in differentiating organ-confined tumours from non-organ-confined tumours were 0.94 and 0.77, respectively. The Spearman's correlation coefficient between the signal enhancement slope of time-intensity curves and tumour stages was 0.88 (p<0.001).
  
  
  CONCLUSIONS
  Gadolinium-enhanced MRI is an appropriate and useful modality with a high accuracy in determining the stage of the bladder cancer. In addition, this method shows extension and progression of tumour and tumour invasion depth.
authors.affiliation: Faculty, Department of Radiology Technology, Shahid Beheshti University of Medical Sciences , Tehran, Iran .
authors.forename: Elham
authors.initials: E
authors.lastname: Rabie
authors.affiliation: Assistant Professor, Department of Radiology Technology, Shahid Beheshti University of Medical Sciences , Tehran, Iran .
authors.forename: Fariborz
authors.initials: F
authors.lastname: Faeghi
authors.affiliation: Assistant Professor, Department of Urology, Al-Zahra Hospital, Isfahan University of Medical Sciences , Isfahan, Iran .
authors.forename: Mohammad-Hossein
authors.initials: MH
authors.lastname: Izadpanahi
authors.affiliation: Assistant Professor, Department of Radiology, Shahrekord University of Medical Sciences , Shahrekord, Iran .
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Dayani
keywords: Bladder Neoplasms; DCE-MRI; Neoplasm staging