Dynamic MRI of Bladder Cancer: Evaluation of Staging Accuracy
Aylin Tekes1,
Ihab Kamel1,
Khursheed Imam1,
Gilberto Szarf1,
Mark Schoenberg2,
Khurram Nasir3,
Richard Thompson4 and
David Bluemke1
1 Russell H. Morgan Department of Radiology, Johns Hopkins School of Medicine,
601 N Caroline St., Ste. 3235A, Baltimore, MD 21287.
2 Department of Urology, Brady Urological Institute, Johns Hopkins School of
Medicine, Baltimore, MD 21287.
3 Johns Hopkins School of Public Health, Baltimore, MD 21287.
4 Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
21287.
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Fig. 1A. —Images in 58-year-old man with correctly staged papillary
(Ta) transitional cell carcinoma of bladder. Axial T2-weighted image (TR/TE,
4,000/80) shows polypoid mass (arrow) arising from right
posterolateral wall with homogeneous low signal intensity. Note that
low-signal muscular layer is intact.
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Fig. 1B. —Images in 58-year-old man with correctly staged papillary
(Ta) transitional cell carcinoma of bladder. Axial arterial phase
gadolinium-enhanced image (200/2.9) shows bright, homogeneous enhancement of
mass (arrow).
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Fig. 2A. —Images in 70-year-old man with correctly staged T2b
transitional cell carcinoma of bladder. Axial T2-weighted image (TR/TE,
4,000/80) shows that sessile mass arising from right lateral wall
(arrow) disrupts low-signal-intensity muscle layer.
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Fig. 2B. —Images in 70-year-old man with correctly staged T2b
transitional cell carcinoma of bladder. Axial arterial phase
gadolinium-enhanced image (200/2.9) shows early enhancement of sessile mass
(arrow).
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Fig. 3A. —Images in 68-year-old man with correctly staged T4a
transitional cell carcinoma of bladder. Axial T2-weighted image (TR/TE,
4,000/80) obtained above level of mass shows two diverticula arising from
ureterovesical junction bilaterally (white arrows) and left
hydroureter (arrowhead). Note enlarged left external iliac lymph
nodes (black arrows).
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Fig. 3B. —Images in 68-year-old man with correctly staged T4a
transitional cell carcinoma of bladder. Axial arterial phase
gadolinium-enhanced image (200/2.9) obtained slightly lower than A shows
polypoid tumor with homogeneous enhancement arising from left base of bladder
(small short arrow) and extending into perivesical fat
(arrowheads). Note that asymmetric enhancement in left seminal
vesicle (large short arrow) correlates with organ invasion at radical
cystectomy. Enlarged right inguinal lymph node (long arrow) also can
be seen.
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Fig. 4A. —Images in 56-year-old woman with stage T3b transitional cell
carcinoma of bladder. Tumor was overstaged by both reviewers. Axial
T2-weighted image (TR/TE, 4,000/80) shows tumor with heterogeneous signal
intensity disrupting bladder wall and causing left hydroureter (large
arrow). Note lymph node in left obturator chain (arrowhead). No
clear fat plane (small arrows) is visible between uterus and tumor,
suggesting uterine invasion. No uterine invasion was detected at
pathology.
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Fig. 4B. —Images in 56-year-old woman with stage T3b transitional cell
carcinoma of bladder. Tumor was overstaged by both reviewers. Axial venous
phase fast spoiled gradient-echo image (200/1.9) obtained after administration
of gadolinium shows intense enhancement of sessile mass arising from left
lateral wall and filling most of bladder lumen. Note loss of fat plane
(arrows) between uterus (arrowhead) and mass.
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Copyright © 2005 by the American Roentgen Ray Society.
