Urinary bladder carcinoma; MR versus CT evaluation

ABSTRACT

Twenty patients with a clinical diagnosis of urinary bladder cancer were selected. Physical examination, cystoscopy, routine ultrasound examination and CT and MR were done to all patients. The most affected patients were, in the sixth and seventh decades. Painless intermittent profuse Hemadurea was the most presenting symptom [90%]. Transitional cell carcinoma was found in 12 patients [60%] while squamous cell carcinoma in only 5 patients. MRI was better than CT in determination of the site of the tumor with an accuracy of 100%. Sagittal sequences were the best in detection of the lateral wall masses. Calcification within the tumor which was present in 30% of cases was better detected in non contrast and immediate post contrast CT. It was found in six cases [30%]. Staging of the twenty cases of bladder cancer was made by clinical, operative, and pathological findings according to 1997 TNM staging system. Stage T1 was found in one case, stage T2a in five cases, stage T2 alpha in five cases, stage T3 in one case, stage T4 alpha in two cases, stage T4b in six cases. By immediate post contrast CT eleven cases were correctly staged, eight cases were over staged while one case was under staged with a total accuracy of 55%. By late post contrast CT ten cases were correctly stage, eight cases were over staged and two cases were under staged with a total accuracy of 50%. By MRI seventeen cases were correctly staged, no cases were under staged, and three cases were over staged with a total accuracy of 85%. MRI equaled CT in detection of muscle infiltration with the same accuracy, sensitivity, and specificity. Moreover, it can differentiate between superficial and deep muscle infiltration. T2 sequence was better than T1 and STIR sequences in differentiation between superficial and deep muscle infiltration with an accuracy of 76.9%, sensitivity of 62.5%, and specificity of 100%. T1 and STIR sequences sere equal in differentiation between superficial and deep muscle infiltration. For detection of perivesical fat infiltration, MRI detected the perivesical fat infiltration with no under or over estimation. The accuracy of CT was 95.2%, the sensitivity was 100%, and the specificity was 92.3%, while, the accuracy of MRI was 100%, the sensitivity was 100%, and the specificity was 100%. MRI was better than CT in detectioin of surrounding organ infiltration with an accuracy of 100%, sensitivity of 100%, and specificity of 100% [e.g. case numer 2]. T2 was beteer than T1 and STIR in detection of surrounding organ infiltration with an accuracy of 100%, sensitivity of 100%, and specificity of 100%. Accuracy of T1 was 75%, sensitivity was 83.3%, and specificity was 73.3%. Accuracy of STIR was 95%, sensitivity was 83.3%, and specificity8 was 100%. CT [Non contrast, immediate post contrast, and late post contrast] and MRI were equal in detection of pelvic bone metastases and all MRI sequences were equal in detection of pelvic bone metastases. Late post contrast CT and MRI were equal in identification of dilated lower ends of the ureters. The aim of this study was to evaluate the role of magnetic resonance imaging versus computed Topography in diagnosis and staging of urinary bladder carcinoma