Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

T1-Staging for Urinary Bladder Cancer with the Stalk and Inchworm Signs with 3.0 Tesla MRI

3.0 테슬러 자기공명영상에서 Stalk 및 Inchworm Sign이 있는 방광암의 T1 병기 진단

  • Da-hoon Kim (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Byung Chul Kang (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Jin Chung (Department of Radiology, Ewha Womans University Mokdong Hospital)
  • 김다훈 (이화여자대학교 목동병원 영상의학과) ;
  • 강병철 (이화여자대학교 목동병원 영상의학과) ;
  • 정진 (이화여자대학교 목동병원 영상의학과)
  • Received : 2019.08.08
  • Accepted : 2019.10.27
  • Published : 2020.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose To evaluate the diagnostic utility of the stalk and the inchworm sign on preoperative MRI for detecting superficial bladder cancers, and to compare the diagnostic performance between the stalk and the inchworm sign. Materials and Methods We retrospectively reviewed 240 patients (505 tumors) who had undergone radical cystectomy. The tumors were classified as follows: superficial or invasive tumors indicated by the stalk or inchworm sign on 3.0 Tesla MRI. We evaluated the diagnostic accuracy of the stalk and inchworm signs, by comparing each finding with the postoperative pathologic T stage. We compared diagnostic performance between them statistically. Results The stalk and inchworm signs showed high specificity (93% and 91%, respectively), positive predictive values (89% and 90%, respectively), and acceptable accuracy (70% and 74%, respectively), but low sensitivity (54% and 61%, respectively) and negative predictive values (60% and 63%, respectively). There was no statistically significant difference between the two signs (p > 0.05). Conclusion Superficial bladder cancers could be differentiated from invasive tumors using the stalk or inchworm sign on MRI.

목적 본 연구의 목적은 수술 전 표재성 방광암(T1 또는 그 이하 병기)을 확인하기 위한 자기공명영상의 stalk sign 및 inchworm sign의 진단적 능력을 평가하는 것이다. 또 다른 목적은 두 sign 간의 진단적 능력의 차이를 비교하는 것이다. 대상과 방법 방광전절제술을 시행 받은 총 240명의 환자들(505개의 종양들)을 후향적으로 검토하였다. 모든 종양은 3.0 테슬러 자기공명영상에서 T2 강조영상의 stalk sign 또는 확산강조영상의 inchworm sign을 발견함으로써 표재성 종양 및 침윤성 종양으로 분류하였다. 이를 수술 후 병리학적 T 병기와 비교함으로써 통계학적으로 진단적 의의를 평가하였고 두 sign 간의 진단적 능력 차이를 비교하였다. 결과 Stalk sign 및 inchworm sign은 높은 특이도(93%, 91%), 양성예측도(89%, 90%), 정확도(70%, 74%)를 보였으나 낮은 민감도(54%, 61%)와 음성예측도(60%, 63%)를 보였다. 두 sign 간의 진단적 능력에서 통계학적 유의미한 차이는 없었다(p > 0.05). 결론 수술 전 T2 강조영상의 stalk sign과 확산가중영상의 inchworm sign을 발견함으로써 표재성 방광암을 쉽게 진단할 수 있다.

Keywords

References

  1. Josephson D, Pasin E, Stein JP. Superficial bladder cancer: part 2. Management. Expert Rev Anticancer Ther 2007;7:567-581 https://doi.org/10.1586/14737140.7.4.567
  2. Sherif A, Jonsson MN, Wiklund NP. Treatment of muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2007;7:1279-1283 https://doi.org/10.1586/14737140.7.9.1279
  3. Tekes A, Kamel I, Imam K, Szarf G, Schoenberg M, Nasir K, et al. Dynamic MRI of bladder cancer: evaluation of staging accuracy. AJR Am J Roentgenol 2005;184:121-127 https://doi.org/10.2214/ajr.184.1.01840121
  4. Hayashi N, Tochigi H, Shiraishi T, Takeda K, Kawamura J. A new staging criterion for bladder carcinoma using gadolinium-enhanced magnetic resonance imaging with an endorectal surface coil: a comparison with ultrasonography. BJU Int 2000;85:32-36 https://doi.org/10.1046/j.1464-410x.2000.00358.x
  5. Tanimoto A, Yuasa Y, Imai Y, Izutsu M, Hiramatsu K, Tachibana M, et al. Bladder tumor staging: comparison of conventional and gadolinium-enhanced dynamic MR imaging and CT. Radiology 1992;185:741-747 https://doi.org/10.1148/radiology.185.3.1438756
  6. Takeuchi M, Sasaki S, Ito M, Okada S, Takahashi S, Kawai T, et al. Urinary bladder cancer: diffusion-weighted MR imaging--accuracy for diagnosing T stage and estimating histologic grade. Radiology 2009;251:112-121 https://doi.org/10.1148/radiol.2511080873
  7. Ohgiya Y, Suyama J, Sai S, Kawahara M, Takeyama N, Ohike N, et al. Preoperative T staging of urinary bladder cancer: efficacy of stalk detection and diagnostic performance of diffusion-weighted imaging at 3T. Magn Reson Med Sci 2014;13:175-181 https://doi.org/10.2463/mrms.2013-0104
  8. Saito W, Amanuma M, Tanaka J, Heshiki A. Histopathological analysis of a bladder cancer stalk observed on MRI. Magn Reson Imaging 2000;18:411-415 https://doi.org/10.1016/S0730-725X(00)00124-7
  9. Wang HJ, Pui MH, Guo Y, Li SR, Guan J, Zhang XL, et al. Multiparametric 3-T MRI for differentiating low-versus high-grade and category T1 versus T2 bladder urothelial carcinoma. AJR Am J Roentgenol 2015;204:330-334 https://doi.org/10.2214/AJR.14.13147
  10. Skinner DG. Current state of classification and staging of bladder cancer. Cancer Research 1977;37:2838-2842
  11. Narumi Y, Kadota T, Inoue E, Kuriyama K, Fujita M, Hosomi N, et al. Bladder tumors: staging with gadolinium-enhanced oblique MR imaging. Radiology 1993;187:145-150 https://doi.org/10.1148/radiology.187.1.8451401
  12. Kobayashi S, Koga F, Yoshida S, Masuda H, Ishii C, Tanaka H, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in bladder cancer: potential utility of apparent diffusion coefficient values as a biomarker to predict clinical aggressiveness. Eur Radiol 2011;21:2178-2186 https://doi.org/10.1007/s00330-011-2174-7
  13. Barentsz JO, Jager GJ, Van Vierzen PB, Witjes JA, Strijk SP, Peters H, et al. Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging. Radiology 1996;201:185-193 https://doi.org/10.1148/radiology.201.1.8816542
  14. Kim SH. Validation of vesical imaging reporting and data system for assessing muscle invasion in bladder tumor. Abdom Radiol 2020;45:491-498 https://doi.org/10.1007/s00261-019-02190-1
  15. Wang H, Luo C, Zhang F, Guan J, Li S, Yao H, et al. Multiparametric MRI for bladder cancer: validation of VIRADS for the detection of detrusor muscle invasion. Radiology 2019;291:668-674 https://doi.org/10.1148/radiol.2019182506