Radiology, Vol 201, 185-193, Copyright © 1996 by Radiological Society of North America

ARTICLES

Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging

JO Barentsz, GJ Jager, PB van Vierzen, JA Witjes, SP Strijk, H Peters, N Karssemeijer and SH Ruijs
Department of Radiology, University Hospital Nijmegen, The Netherlands.

PURPOSE: To evaluate contrast enhancement patterns of urinary bladder cancer and surrounding structures and to evaluate a fast dynamic first- pass magnetic resonance (MR) imaging technique in tumor and node staging and in differentiation of urinary bladder cancer from postbiopsy effects. MATERIALS AND METHODS: Sixty-one consecutive patients with histologically proved urinary bladder cancer were referred to undergo unenhanced and dynamic MR imaging 1-4 weeks after transurethral resection or biopsy. Subtraction and time (to beginning of enhancement) images were acquired. RESULTS: Results with unenhanced T1- and T2-weighted images were compared with those obtained with the unenhanced images plus dynamic contrast material-enhanced single- section turbo fast low-angle shot (FLASH) images. Urinary bladder cancer started to enhance 6.5 seconds +/- 3.5 (standard deviation) after the beginning of arterial enhancement, which was 4 seconds earlier than most other structures (postbiopsy tissue, 13.6 seconds +/- 4.2). In differentiation of postbiopsy tissue from malignancy on the basis of the beginning of enhancement depicted on time and subtracted images, accuracy improved from 79% to 90% (P < .02) and specificity improved from 33% to 92% (not significant). Overall, tumor staging accuracy improved significantly from 67% to 84% (P < .01) by adding the turbo FLASH images. CONCLUSION: Fast dynamic first-pass MR imaging, with at least one image acquired every 2 seconds, improved delineation of urinary bladder cancer, tumor staging, and detection of metastases.

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