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Bladder Tumor Staging: Comparison of Contrast-Enhanced and Gray-Scale Ultrasound

¹ All authors: Dipartimento di Biotecnologie mediche e Medicina legale, Sezione di scienze radiologiche, Università degli Studi di Palermo, Via del Vespro 127, Palermo 90127, Italy.

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.

SUBJECTS AND 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).

CONCLUSION. Our study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.

Keywords: contrast agent • staging • tumor • ultrasonography • ultrasound • urinary bladder

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