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Dynamic MRI of Bladder Cancer: Evaluation of Staging Accuracy

¹ Russell H. Morgan Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St., Ste. 3235A, Baltimore, MD 21287.
² Department of Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287.
³ Johns Hopkins School of Public Health, Baltimore, MD 21287.
⁴ Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD 21287.

OBJECTIVE. The purpose of this study was to evaluate the accuracy of gadoliniumenhanced MRI in staging bladder cancer in a series of patients with surgically proven bladder cancer.

MATERIALS AND METHODS. Seventy-one patients with biopsy-proven bladder cancer underwent MRI on a 1.5-T scanner with a phased-array pelvic coil. Conventional T1-weighted spin-echo, T2-weighted spin-echo, and unenhanced and enhanced (0.1 mmol/kg gadolinium) fast spoiled gradient-echo images with fat suppression were obtained. Two blinded reviewers evaluated the MR images and assigned a stage that was compared with the pathologic stage (n = 67) or with clinical follow-up for at least 2 years after MRI (n = 4).

RESULTS. Agreement among the reviewers was good in assigning a radiologic stage for bladder cancer (kappa = 0.80). On a stage-by-stage basis, MRI accuracy was 62%, and overstaging was the most common error (32%). Staging accuracy improved to 85% and 82% in differentiating superficial from invasive tumors and organ-confined from non-organ-confined tumors, respectively. The time interval between MRI and transurethral resection ( 60 days and 61 days) was not a statistically significant factor in differentiating superficial from invasive and organ-confined from non-organ-confined tumors (p > 0.05). MRI accuracy in staging transitional cell carcinoma was not significantly different from that obtained in staging non–transitional cell carcinoma (p > 0.05).

CONCLUSION. MRI shows good reproducibility between reviewers for staging bladder cancer. Although overall staging accuracy was only moderate, the accuracy for differentiating superficial versus invasive disease and organ-confined versus non-organ-confined disease was high.

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