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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).

View larger version (180K): [in a new window]   Figure 1a. Transverse dynamic contrast-enhanced multiphasic CT images of bladder cancer. (a) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 77 HU. (b) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 108 HU. (c) An 80-second delayed CT image; the attenuation value of bladder cancer (arrow) is 93 HU. (d) A 100-second delayed CT image; the attenuation value of bladder cancer (arrow) is 82 HU.

View larger version (180K): [in a new window]   Figure 1b. Transverse dynamic contrast-enhanced multiphasic CT images of bladder cancer. (a) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 77 HU. (b) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 108 HU. (c) An 80-second delayed CT image; the attenuation value of bladder cancer (arrow) is 93 HU. (d) A 100-second delayed CT image; the attenuation value of bladder cancer (arrow) is 82 HU.

View larger version (184K): [in a new window]   Figure 1c. Transverse dynamic contrast-enhanced multiphasic CT images of bladder cancer. (a) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 77 HU. (b) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 108 HU. (c) An 80-second delayed CT image; the attenuation value of bladder cancer (arrow) is 93 HU. (d) A 100-second delayed CT image; the attenuation value of bladder cancer (arrow) is 82 HU.

View larger version (185K): [in a new window]   Figure 1d. Transverse dynamic contrast-enhanced multiphasic CT images of bladder cancer. (a) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 77 HU. (b) A 60-second delayed CT image; the attenuation value of bladder cancer (arrow) is 108 HU. (c) An 80-second delayed CT image; the attenuation value of bladder cancer (arrow) is 93 HU. (d) A 100-second delayed CT image; the attenuation value of bladder cancer (arrow) is 82 HU.

View larger version (166K): [in a new window]   Figure 2. Image in a 57-year-old man who underwent TURB 16 days before CT. Transverse 60-second delayed CT image shows two strongly enhancing nodules (large arrow and arrowhead) with a maximal diameter of 3 mm that were diagnosed as transitional cell carcinomas at histologic examination of radical cystectomy specimen. Focal wall thickening (small arrows) of the bladder wall due to previous TURB does not contain any additional tumor and enhances much less intensely than the bladder cancers, which allows it to be differentiated from malignancy.

View larger version (156K): [in a new window]   Figure 3. Image in a 48-year-old man underwent TURB 4 days before CT. Transverse 60-second delayed CT image shows focal wall thickening (arrows) with linear enhancement. We considered this lesion to be bladder cancer; however, histologic examination of the radical cystectomy specimens showed no residual tumor, only focal inflammation and fibrosis.

View larger version (149K): [in a new window]   Figure 4. Image in a 64-year-old woman with bladder cancer invading perivesical fat. Transverse 60-second delayed CT image shows diffuse wall thickening with enhancement on the right side of the bladder. The interface (arrowheads) between the bladder cancer and perivesical fat is irregular, suggesting perivesical fat invasion of bladder cancer. Histologic examination confirmed a diagnosis of bladder cancer with perivesical invasion.

View larger version (147K): [in a new window]   Figure 5. Image in a 59-year-old man with bladder cancer who underwent TURB 2 days before CT. Transverse 60-second delayed CT image shows diffuse wall thickening with strong enhancement and wide perivesical fat infiltration (arrowheads) around the bladder cancer, which suggests perivesical fat invasion. Histologic examination of radical cystectomy specimens, however, showed the bladder cancer was confined to the bladder wall, without perivesical invasion.