An evaluation of morphological and functional multi-parametric MRI sequences in classifying non-muscle and muscle invasive bladder cancer.
OBJECTIVE
Our goal is to determine the ability of multi-parametric magnetic resonance imaging (mpMRI) to differentiate muscle invasive bladder cancer (MIBC) from non-muscle invasive bladder cancer (NMIBC).


METHODS
Patients underwent mpMRI before tumour resection. Four MRI sets, i.e. T2-weighted (T2W) + perfusion-weighted imaging (PWI), T2W plus diffusion-weighted imaging (DWI), T2W + DWI + PWI, and T2W + DWI + PWI + dif-fusion tensor imaging (DTI) were interpreted qualitatively by two radiologists, blinded to histology results. PWI, DWI and DTI were also analysed quantitatively. Accuracy was determined using histopathology as the reference standard.


RESULTS
A total of 82 tumours were analysed. Ninety-six percent of T1-labeled tumours by the T2W + DWI + PWI image set were confirmed to be NMIBC at histopathology. Overall accuracy of the complete mpMRI protocol was 94% in differentiating NMIBC from MIBC. PWI, DWI and DTI quantitative parameters were shown to be significantly different in cancerous versus non-cancerous areas within the bladder wall in T2-labelled lesions.


CONCLUSIONS
MpMRI with DWI and DTI appears a reliable staging tool for bladder cancer. If our data are validated, then mpMRI could precede cystoscopic resection to allow a faster recognition of MIBC and accelerated treatment pathways.


CONCLUSIONS
• A critical step in BCa staging is to differentiate NMIBC from MIBC. • Morphological and functional sequences are reliable techniques in differentiating NMIBC from MIBC. • Diffusion tensor imaging could be an additional tool in BCa staging.
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy. Valeria.panebianco@uniroma1.it.
Valeria
V
Panebianco
Department of Gynaecological-Obstetric and Urological Sciences, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Ettore
E
De Berardinis
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Giovanni
G
Barchetti
Department of Urology, "Regina Elena" National Cancer Insitute, Via Elio Chianesi, 53, 00144, Rome, Italy.
Giuseppe
G
Simone
Department of Gynaecological-Obstetric and Urological Sciences, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Constantino
C
Leonardo
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Marcello Domenico
MD
Grompone
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Maurizio
M
Del Monte
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Davide
D
Carano
Department of Urology, "Regina Elena" National Cancer Insitute, Via Elio Chianesi, 53, 00144, Rome, Italy.
Michele
M
Gallucci
Academic Urology Unit, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
James
J
Catto
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
Carlo
C
Catalano
D000368:Aged; D000369:Aged, 80 and over; D056324:Diffusion Tensor Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology*
Bladder cancer; Diffusion tensor imaging; Diffusion-weighted imaging; Multiparametric magnetic resonance imaging; Staging