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Bladder Cancer: Analysis of Multi–Detector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging¹

¹ From the Departments of Radiology (J.K.K., S.Y.P., K.S.C.) and Urology (C.S.K., H.J.A.), Asan Medical Center, University of Ulsan, 388–1 Poongnap-dong, Songpa-gu, Seoul 138–736, Korea. Received October 1, 2002; revision requested December 12; final revision received September 24, 2003; accepted October 28. Address correspondence to K.S.C. (e-mail: kscho@amc.seoul.kr).

PURPOSE: To evaluate the enhancement pattern of bladder cancer and the accuracy of multi–detector row helical computed tomography (CT) in the detection and staging of bladder cancer.

MATERIALS AND METHODS: In 20 patients, the attenuation value of bladder cancer was measured on dynamic contrast material–enhanced multiphasic CT images obtained with scanning delays of 40, 60, 80, and 100 seconds. In 67 patients, CT data were obtained with a 60-second scanning delay that covered the bladder (section thickness, 2.5 mm; beam pitch, 1.5) and a 180-second scanning delay that covered the abdomen (section thickness, 5 mm; beam pitch, 1.5). We prospectively evaluated CT images and compared findings at CT with findings at histologic examination. We evaluated cancer detection rate, positive predictive value of cancer detection, and sensitivity and specificity in the diagnosis of perivesical invasion.

RESULTS: The attenuation value of bladder cancers was significantly higher on 60- (105 HU ± 16) and 80-second (97 HU ± 15) delayed CT images than on the other images (P < .05). The cancer detection rate and positive predictive value for cancer detection were 97% and 95%, respectively, in 67 patients and increased to 100% and 100%, respectively, in 44 patients with a time interval of 7 or more days between transurethral resection of the bladder (TURB) and CT examination. Sensitivity and specificity in the diagnosis of perivesical invasion were 89% and 95%, respectively, in 67 patients and increased to 92% and 98%, respectively, in 44 patients with a time interval of 7 or more days between TURB and CT examination.

CONCLUSION: Bladder cancer tends to show peak enhancement with the 60-second scanning delay. Multi–detector row helical CT is useful in the detection and staging of bladder cancer.

© RSNA, 2004

Index terms: Bladder neoplasms, 83.32 • Bladder neoplasms, CT, 83.12115, 83.12112 • Computed tomography (CT), contrast enhancement, 83.12112 • Computed tomography (CT), multi–detector row, 83.12115

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