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Gadolinium-Enhanced Fat-Suppressed T1-Weighted Imaging for Staging Ureteral Carcinoma: Correlation with Histopathology

Masao Obuchi1,2, Kousei Ishigami3, Koji Takahashi4, Minoru Honda5, Toshiyuki Mitsuya6, David M. Kuehn2, Alan H. Stolpen2, Bruce P. Brown2 and Akihiro Nishie3

1 Present address: Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-0043, Japan.
2 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242.
3 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
4 Department of Radiology, Asahikawa Medical College, Midorigaoka, Asahikawa, Japan.
5 Department of Radiology, Showa University Hospital, Shinagawa-ku, Tokyo, Japan.
6 Department of Pathology, Showa University Fujigaoka Hospital, Aoba-ku, Yokohama, Japan.


Figure 1
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  		Fig. 1A —Stage pT1 transitional cell carcinoma (TCC) of left ureteropelvic junction. Coronal gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 90 seconds after IV administration of gadolinium in 79-year-old man (case 1 in Table 1) and schema (B) corresponding to circled region in A show intensely enhancing rim (arrows) and moderately enhancing mass (arrowheads).

 

Figure 2
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  		Fig. 1B —Stage pT1 transitional cell carcinoma (TCC) of left ureteropelvic junction. Coronal gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 90 seconds after IV administration of gadolinium in 79-year-old man (case 1 in Table 1) and schema (B) corresponding to circled region in A show intensely enhancing rim (arrows) and moderately enhancing mass (arrowheads).

 

Figure 3
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  		Fig. 1C —Stage pT1 transitional cell carcinoma (TCC) of left ureteropelvic junction. Photograph of pathologic specimen from patient in A shows TCC (arrowheads) that is confined to submucosa and thickened muscularis or adventitia due to proliferation of fibrous tissue (arrows). Intensely enhancing rim corresponds to thickened muscularis or adventitia due to proliferation of fibrous tissue. Moderately enhancing mass corresponds to TCC. (H and E, loupe)

 

Figure 4
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  		Fig. 2A —Stage pT3 squamous cell carcinoma (SCC) of right distal ureter. Axial gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 210 seconds after IV administration of gadolinium in 78-year-old woman (case 9 in Table 1) and schema (B) corresponding to circled region in A show intensely enhancing rim (white arrows), relatively moderate enhancing ill-defined mass (arrowheads), and poorly enhancing region (curved arrow). Intensely enhancing rim is disrupted in its left to posterior aspect (straight black arrow, B), and relatively moderate enhancing ill-defined mass is spread inside and outside of disrupted portion.

 

Figure 5
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  		Fig. 2B —Stage pT3 squamous cell carcinoma (SCC) of right distal ureter. Axial gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 210 seconds after IV administration of gadolinium in 78-year-old woman (case 9 in Table 1) and schema (B) corresponding to circled region in A show intensely enhancing rim (white arrows), relatively moderate enhancing ill-defined mass (arrowheads), and poorly enhancing region (curved arrow). Intensely enhancing rim is disrupted in its left to posterior aspect (straight black arrow, B), and relatively moderate enhancing ill-defined mass is spread inside and outside of disrupted portion.

 

Figure 6
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  		Fig. 2C —Stage pT3 squamous cell carcinoma (SCC) of right distal ureter. Photograph of pathologic specimen shows SCC (white arrowheads) and thickening of both muscularis and adventitia (white arrows) due to marked proliferation of fibrous tissue that is partially invaded by SCC. Necrotic change is also depicted in tumor (curved arrow). Tumor invaded into periureteral fat tissue through area in thickened muscularis, and adventitia (black arrow) was disrupted. Intensely enhancing rim corresponds to thickened muscularis and adventitia due to proliferation of fibrous tissue. Relatively moderate enhancing ill-defined mass corresponds to SCC. Poorly enhancing region corresponds to necrotic tissue in tumor. (H and E, loupe)

 

Figure 7
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  		Fig. 3A —Stage pT1 transitional cell carcinoma (TCC) of right distal ureter. Axial gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 210 seconds after IV administration of gadolinium in 70-year-old woman (case 2 in Table 1) and schema (B) corresponding to circled region in A show that intensely enhancing rim is clearly visible and that smooth margin (arrow) is not disrupted. Pathologically, carcinoma is confined to submucosa, and marked fibrous proliferation is noted in adventitia of ureteral wall and in periureteral fat tissue.

 

Figure 8
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  		Fig. 3B —Stage pT1 transitional cell carcinoma (TCC) of right distal ureter. Axial gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 210 seconds after IV administration of gadolinium in 70-year-old woman (case 2 in Table 1) and schema (B) corresponding to circled region in A show that intensely enhancing rim is clearly visible and that smooth margin (arrow) is not disrupted. Pathologically, carcinoma is confined to submucosa, and marked fibrous proliferation is noted in adventitia of ureteral wall and in periureteral fat tissue.

 

Figure 9
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  		Fig. 4A —Stage pT3 transitional cell carcinoma of right distal ureter. Axial gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 210 seconds after IV administration of gadolinium in 73-year-old man (case 8 in Table 1) and schema (B) corresponding to circled region in A show intensely enhanced bandlike structure (arrows) that is irregular and disrupted. Moderately enhancing, irregular-shaped mass is depicted, and it invades periureteral tissue (arrowheads). Pathologically, carcinoma invaded periureteral fat tissue.

 

Figure 10
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  		Fig. 4B —Stage pT3 transitional cell carcinoma of right distal ureter. Axial gadolinium-enhanced fat-suppressed T1-weighted image (A) obtained 210 seconds after IV administration of gadolinium in 73-year-old man (case 8 in Table 1) and schema (B) corresponding to circled region in A show intensely enhanced bandlike structure (arrows) that is irregular and disrupted. Moderately enhancing, irregular-shaped mass is depicted, and it invades periureteral tissue (arrowheads). Pathologically, carcinoma invaded periureteral fat tissue.

 

Figure 11
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  		Fig. 5A —Schemas show proposed MR criteria in T staging of ureteral carcinoma based on our results. When intensely enhancing rim (arrow) is clearly visible and its smooth margin is not disrupted, tumor does not invade into periureteral tissue and is less than stage pT2.

 

Figure 12
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  		Fig. 5B —Schemas show proposed MR criteria in T staging of ureteral carcinoma based on our results. When intensely enhancing rim (arrows) is disrupted or fragmented, findings indicate that tumor does invade periureteral tissue and is stage pT3 or pT4.

 

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