Dynamic magnetic-resonance cystography in diagnosis of perivesical fat invasion in bladder cancer

Objective: to evaluate the diagnostic capabilities of the dynamic magnetic-resonance cystography technique in detecting invasion of perivesical fat in case of bladder cancer.

Materials and methods. The study included 125 patients (105 male and 20 females, mean 62.6 Ѓ} 11.0 years) with transitional cell carcinoma of the bladder. To assess the accuracy of the dynamic cystography method, cases with a tumor size of more than 20 mm, affecting the wall outside the bladder triangle, were selected with suspicion of perivesical fat invasion on magnetic-resonance scans. A furacilin solution was fractional injected into the catheterized bladder to obtain repeated series of T2‑haste-FS images until the bladder was completely expanded.

Results. In postprocessing, the selection of areas of interest (ROI) was performed along the contour of the affected wall in the cross section through the center of the tumor. Comparison of the displacement of the affected and intact walls by a diagram of the values of the intensity of the magnetic-resonance signal in the dynamics of bladder dilatation was evaluated. The verification method was the morphological study of the surgical material after the operative treatment. The limit of values with a more likely lesion of perivesical fat was found, which is less than 11 % of the intensity change of the magnetic-resonance signal in selected ROIs during bladder wall expansion.

Conclusion. The effectiveness of dynamic magnetic-resonance cystography in the differential diagnosis of perivesical fat infiltration in bladder cancer is characterized by a sensitivity of 90.0 %, a specificity of 93.3 %, and an accuracy of 92.0 %. The proposed technique improves the accuracy of the magnetic resonance imaging method with suspected infiltration of perivesical fat and is well tolerated by patients.

1. Malignant tumors in Russia in 2016 (morbidity and mortality). Eds.: А.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMIRTS radiologii” Minzdrava Rossii, 2018. 250 p. (In Russ.).

2. Babjuk M., Böhle A., Burger M. et al. EAU Guidelines on Non-Muscleinvasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol 2016;71(3):447–61. DOI: 10.1016/j.eururo.2016.05.041.

3. Bostrom P.J., van Rhijn B.W.G., Fleshner N. et al. Staging and Staging Errors in Bladder Cancer. Eur Urol Suppl 2010;9(1):2–9. DOI: org/10.1016/j.eursup.2010.01.0059.

4. Grigoriev E.G., Frolova I.G., Velichko S.A. Lieutaud’s triangle lesion and urodynamic disorders in bladder cancer according to magnetic resonance imaging data. Vestnik rentgenologii i radiologii = Journal of Radiology and Nuclear Medicine 2015;(3):31–8. [(In Russ.).

5. Alfred Witjes J., Lebret T., Compérat E.M. et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017;71(3):462–75. DOI: 10.1016/j.eururo.2016.06.020.

6. Yoshida S., Koga F., Kobayashi S. et al. Diffusion-weighted magnetic resonance imaging in management of bladder cancer, particularly with multimodal bladder-sparing strategy. World J Radiol 2014;6(6):344–54. DOI: 10.4329/wjr.v6.i6.344.

7. Sobin L.Kh., Gospodarovich M.K. TNM Classification of malignant tumors. 7th ed. Moscow: Logosphera, 2011. (In Russ.).

8. Frolova I.G., Grigoriev E.G., Trukhache va N.G., Usova A.V. Role of High-Resolution Magnetic Resonance Imaging in Diagnosis of Bladder Cancer. Meditsinskaya vizualizatsiya = Medical visualization 2016;(2):49–56. (In Russ.).

9. Takeuchi M., Sasaki S., Naiki T. et al. MR imaging of urinary bladder cancer for T-staging: а review and a pictorial essay of diffusion-weighted imaging. J Magn Reson Imaging 2013;38(6): 1299–309. DOI: 10.1002/jmri.24227.

10. Hafeez S., Huddart R. Advances in bladder cancer imaging. BMC Medicine Springer Science and Business Media LLC 2013;11(1). DOI: 10.1186/17417015-11-104. Available at: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-104.

11. Dolgushin B.I., Tyurin I.E. Standards of ultrasound, CT, MRI and PET/ CT studies in oncology. Moscow: FSBI “N.N. Blokhin Russian Cancer Research Center”, Ministry of Health of the Russian Federation, 2016. (In Russ.).