Online ISSN: 2515-8260

Author : Abdelsamad, Khalid Mohamed

Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Non Muscle Invasive Bladder Cancer Correlated to the Second Cystoscopy

Khalid Mohamed Abdelsamad; Khaled Mohamed Abdelwahab; Maged Mohamed Ali; Ahmed Saad Mohammed El-Shorbagy

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 2412-2419

Background: Proper management of the urinary bladder cancer depends on the stage of the lesions. The aim of this work was to correlate between the outcomes of DW-MRI results and biopsy results of 2nd look TURBT in NMIBC and to correlate between DW-MRI and conventional MRI in NMIBC. Patients and methods: It was a prospective study included twenty four patients with NMIBC underwent 2nd look TURBT with preoperative imaging with DW-MRI on pelvis. Bladder mapping was done on 1.5 T Philips Achieva system class II MRI device is used. T1andT2 weighted is used for anatomical and morphological evaluation. Diffusion-weighted images were obtained by using single shot echoplanar imaging with a pair of rectangular gradient pulses along three orthogonal axes. Second look cystoscopy and biopsy was performed under spinal anesthesia. Resection of lateral wall bladder tumors was performed under general anesthetic with a paralytic agent to avoid inadvertent bladder wall perforation from an obturator nerve reflex .Biopsy was taken from the tumor base or residual of the mass if present for histopathological examination Results: Sensitivity of DW-MRI was 100%, specificity was 92.8% and accuracy was 96.8% in prediction of malignancy, while Sensitivity of DW-MRI was 83.33%, specificity was 80% and accuracy was 81.25% in prediction of muscle invasion tumors. 14 of the 32 lesions analyzed in the second TURB were diagnosed as MIBC. There was a significant correlation between clinical staging by DW-MRI and pathological staging Conclusion: This study show the superiority of DWMRI to T1W- and T2WMRI in differentiating residual bladder cancer from postoperative changes after an initial TURB. DW-MRI showed reasonable high sensitivity, specificity, accuracy and agreement compared to the results of the gold standard pathological examination of urinary bladder tumors. DW-MRI can be a useful adjunct for optimal selection of patients for a second TURB. It can replace the diagnostic part of second look cystoscopy