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Stomp-Agenant M, van Dijk T, R Onur A, Grimbergen M, van Melick H, Jonges T, Bosch R, van Swol C. In vivo Raman spectroscopy for bladder cancer detection using a superficial Raman probe compared to a nonsuperficial Raman probe. JOURNAL OF BIOPHOTONICS 2022; 15:e202100354. [PMID: 35233990 DOI: 10.1002/jbio.202100354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
Raman spectroscopy is promising as a noninvasive tool for cancer diagnosis. A superficial Raman probe might improve the classification of bladder cancer, because information is gained solely from the diseased tissue and irrelevant information from deeper layers is omitted. We compared Raman measurements of a superficial to a nonsuperficial probe, in bladder cancer diagnosis. Two-hundred sixteen Raman measurements and biopsies were taken in vivo from at least one suspicious and one unsuspicious bladder location in 104 patients. A Raman classification model was constructed based on histopathology, using a principal-component fed linear-discriminant-analysis and leave-one-person-out cross-validation. The diagnostic ability measured in area under the receiver operating characteristics curve was 0.95 and 0.80, the sensitivity was 90% and 85% and the specificity was 87% and 88% for the superficial and the nonsuperficial probe, respectively. We found inflammation to be a confounder and additionally we found a gradual transition from benign to low-grade to high-grade urothelial carcinoma. Raman spectroscopy provides additional information to histopathology and the diagnostic value using a superficial probe.
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Affiliation(s)
- Michelle Stomp-Agenant
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas van Dijk
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Alexander R Onur
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Matthijs Grimbergen
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Harm van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Trudy Jonges
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christiaan van Swol
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
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Tawfeek A, Mostafa D, Mahmoud M, Radwan A, Hamza I. The role of 3-dimensional sonography and virtual sonographic cystscopy in detection of bladder tumors. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Basssiouny RH, Elia RZ. Recurrent bladder tumors after transurethral resection: Diagnostic yield of MDCT-virtual cystoscopy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Computed tomography virtual cystoscopy for follow-up of patients with superficial bladder tumours in comparison to conventional cystoscopy: An exploratory study. Arab J Urol 2016; 14:192-7. [PMID: 27547459 PMCID: PMC4983164 DOI: 10.1016/j.aju.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/18/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate and analyse the efficacy of computed tomography (CT) virtual cystoscopy in comparison to conventional cystoscopy for the follow-up of patients with non-muscle-invasive bladder cancer. Patients and methods The study was done over 3 years, from April 2010 to June 2013, and included 30 patients who all had non-muscle-invasive transitional cell carcinoma (Ta, T1). The patients all underwent complete transurethral resection of the tumour and presented for first follow-up check cystoscopy. The examination was performed using a 16-slice multi-detector (MD) CT scanner. The results were compared for sensitivity and specificity in relation to the site, size, and shape of the tumour. Results In all, 20 lesions were detected by CT virtual cystoscopy in 18 patients, whilst the remaining 12 were lesion free. Conventional cystoscopy, detected 23 lesions in 19 patients. The sensitivity of the virtual images was 87%; its specificity in identifying lesions was 100%, with a positive predictive value of 100% and negative predictive value of 78.5%. Conclusion CT virtual cystoscopy is a promising technique for detecting bladder tumours and some other bladder lesions. However, the detection rate for recurrent NMIBC does not appear to be adequate to replace conventional cystoscopy.
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Can CT Virtual Cystoscopy Replace Conventional Cystoscopy in Early Detection of Bladder Cancer? Adv Urol 2015; 2015:926590. [PMID: 26600802 PMCID: PMC4639634 DOI: 10.1155/2015/926590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/11/2015] [Indexed: 12/04/2022] Open
Abstract
Aim. To correlate findings of conventional cystoscopy with CT virtual cystoscopy (CTVC) in detecting bladder tumors and to evaluate accuracy of virtual cystoscopy in early detection of bladder cancer. Material and Method. From June 2013 to June 2014, 50 patients (46 males, four females) with history and investigations suggestive of urothelial cancer, with mean age 62.76 ± 10.45 years, underwent CTVC by a radiologist as per protocol and subsequently underwent conventional cystoscopy (CPE) the same day or the next day. One urologist and one radiologist, blinded to the findings of conventional cystoscopy, independently interpreted the images, and any discrepant readings were resolved with consensus. Result. CTVC detected 23 out of 25 patients with bladder tumor(s) correctly. Two patients were falsely detected as negative while two were falsely labeled as positive in CTVC. Virtual and conventional cystoscopy were comparable in detection of tumor growth in urinary bladder. The sensitivity, specificity, positive predictive value, and negative predictive value of virtual cystoscopy were 92% each. Conclusion. CTVC correlates closely with the findings of conventional cystoscopy. Bladder should be adequately distended and devoid of urine at the time of procedure. However, more studies are required to define the role of virtual cystoscopy in routine clinical practice.
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MDCT Urography for Detecting Recurrence After Transurethral Resection of Bladder Cancer: Comparison of Nephrographic Phase With Pyelographic Phase. AJR Am J Roentgenol 2014; 203:1021-7. [DOI: 10.2214/ajr.13.12068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shebrya NH, El Hamayed HFA, Botros SM, Shoeb MS. Role of 3-dimensional ultrasonography and virtual cystoscopy in detection of bladder lesions in patients with hematuria. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hsp74, a potential bladder cancer marker, has direct interaction with keratin 1. J Immunol Res 2014; 2014:492849. [PMID: 25050384 PMCID: PMC4094855 DOI: 10.1155/2014/492849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/17/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023] Open
Abstract
Early diagnosis and prognosis monitoring are very important for the survival of patients with bladder cancer. To identify candidate biomarkers of bladder cancer, we used a combination of techniques including 2-DE, co-IP, western blot, LC-MS/MS, and immunohistochemistry. Hsp74 was identified with high expression in bladder cancer. The cellular location of expression products of gene Hsp74 showed that they were distributed into cytoplasm and keratin 1 was found to be associated with Hsp74. The results provide a new idea to understand the molecular basis of bladder cancer progression and pinpoint new potential molecular target for early diagnosis and therapeutic monitoring of bladder cancer.
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Role of multidetector computed tomography virtual cystoscopy in evaluation of urinary bladder carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The Role of Virtual Cystoscopy, after Multidetector Computed Tomography Imaging Reconstruction without the Use of Contrast Medium, in the Diagnosis and Evaluations of Bladder Tumors: Preliminary Study. Adv Urol 2014; 2014:923958. [PMID: 24799894 PMCID: PMC3996888 DOI: 10.1155/2014/923958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/09/2014] [Indexed: 12/01/2022] Open
Abstract
Introduction. Although conventional cystoscopy is considered to be the gold standard for diagnosis and follow-up of bladder tumors, it remains an invasive and costly procedure. With the advent of the multidetector CT (MDCT) scanners supported by specialized software virtual cystoscopy (VC) is possible. We assess the role of VC in diagnosing and evaluating bladder lesions. Materials and Methods. Between September 2010 and October 2011, 25 consecutive patients with cystoscopically confirmed bladder tumor underwent VC. The radiologists involved in this prospective study were blinded to the exact findings. After draining any residual urine with a catheter, the bladder was retrogradely insufflated with 200–600 cc of air. No intravenous or intravesical contrast was used. MDCT scan was performed in supine and prone positions and three-dimensional reconstruction of the urinary bladder was performed. Results. The examination was well tolerated by all patients with no complications. In total, 43 lesions were detected both with conventional cystoscopy and VC. Tumor size measured by CT ranged from 3 to 80 mm in diameter. The pathological report revealed noninvasive transitional cell carcinomas in all cases. Conclusion. VC has promising results in detecting exophytic bladder lesions. In the future it could be part of the diagnostic algorithm for bladder tumors.
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Battista G, Sassi C, Corcioni B, Bazzocchi A, Golfieri R, Canini R. Latest developments in imaging of bladder cancer. Expert Rev Anticancer Ther 2014; 10:881-94. [DOI: 10.1586/era.10.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Reddy K, Mohammed A, Reeve R, England R. Computed tomography urography 1: techniques and technology. Br J Hosp Med (Lond) 2013; 74:571-6. [DOI: 10.12968/hmed.2013.74.10.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Contrast-enhanced computed tomography urography has become possible because of the development of multidetector technology, which has evolved to try and increase its diagnostic efficacy and reduce the radiation exposure. This review highlights important aspects of computed tomography urography as an imaging technique.
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Affiliation(s)
| | | | | | - Roland England
- Department of Urology, Kettering General Hospital, Kettering, Northants NN16 8UZ
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Gabr AH, Elbadry M, Elsherief A, Tawfiek ER. Computed tomography-virtual cystoscopy in the evaluation of a bladder mass: Could it replace standard conventional cystoscopy? Arab J Urol 2013; 11:369-74. [PMID: 26566456 PMCID: PMC4582599 DOI: 10.1016/j.aju.2013.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 11/19/2022] Open
Abstract
Objective To determine the role of computed tomography-virtual cystoscopy (CT-VC) in the detection and evaluation of bladder cancer, compared to standard conventional cystoscopy (CC). Patients and methods Twenty-five patients with a clinical presentation of a bladder mass(es) were selected from an outpatient urology clinic between May 2011 and August 2012. All patients were then assessed using multi-slice CT of the bladder, CT-VC and CC. The results were then compared amongst axial CT images, multiplanar reconstruction (MPR) images, CT-VC and CC, and compared with the pathological results. Results Forty lesions were found at CC in the 25 patients. MPR images had a greater sensitivity for detecting small masses of ⩽5 mm, and for identifying the location of the masses, especially basal (100%), than had axial images. The diagnostic results varied significantly (P = 0.031 and 0.039) between CC and axial images. The difference was slightly significant (P = 0.063) for MPR images and was not significant (P = 0.99) for virtual images. Conclusions Compared to CC, CT-VC was much less invasive, but it was not possible to take a biopsy and provide tissue for histopathology, and it could not depict flat lesions or mucosal colour changes. Therefore, CT-VC could be considered for bladder mapping before CC, in the follow-up of patients with superficial transitional cell carcinoma after transurethral resection of the tumour, in combination with urine cytology, and for patients in whom CC is difficult or contraindicated.
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Affiliation(s)
- Ahmed H. Gabr
- Urology Department, Minia University, Minia, Egypt
- Corresponding author. Tel.: +20 1002557332.
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Han H, Li L, Duan C, Zhang H, Zhao Y, Liang Z. A unified EM approach to bladder wall segmentation with coupled level-set constraints. Med Image Anal 2013; 17:1192-205. [PMID: 24001932 DOI: 10.1016/j.media.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 08/02/2013] [Accepted: 08/06/2013] [Indexed: 01/02/2023]
Abstract
Magnetic resonance (MR) imaging-based virtual cystoscopy (VCys), as a non-invasive, safe and cost-effective technique, has shown its promising virtue for early diagnosis and recurrence management of bladder carcinoma. One primary goal of VCys is to identify bladder lesions with abnormal bladder wall thickness, and consequently a precise segmentation of the inner and outer borders of the wall is required. In this paper, we propose a unified expectation-maximization (EM) approach to the maximum-a posteriori (MAP) solution of bladder wall segmentation, by integrating a novel adaptive Markov random field (AMRF) model and the coupled level-set (CLS) information into the prior term. The proposed approach is applied to the segmentation of T(1)-weighted MR images, where the wall is enhanced while the urine and surrounding soft tissues are suppressed. By introducing scale-adaptive neighborhoods as well as adaptive weights into the conventional MRF model, the AMRF model takes into account the local information more accurately. In order to mitigate the influence of image artifacts adjacent to the bladder wall and to preserve the continuity of the wall surface, we apply geometrical constraints on the wall using our previously developed CLS method. This paper not only evaluates the robustness of the presented approach against the known ground truth of simulated digital phantoms, but further compares its performance with our previous CLS approach via both volunteer and patient studies. Statistical analysis on experts' scores of the segmented borders from both approaches demonstrates that our new scheme is more effective in extracting the bladder wall. Based on the wall thickness calibrated from the segmented single-layer borders, a three-dimensional virtual bladder model can be constructed and the wall thickness can be mapped onto the model, where the bladder lesions will be eventually detected via experts' visualization and/or computer-aided detection.
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Affiliation(s)
- Hao Han
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA
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Lin Q, Liang Z, Duan C, Ma J, Li H, Roque C, Yang J, Zhang G, Lu H, He X. Motion correction for MR cystography by an image processing approach. IEEE Trans Biomed Eng 2013; 60:2401-10. [PMID: 23591468 DOI: 10.1109/tbme.2013.2257769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance (MR) cystography or MR-based virtual cystoscopy is a promising new technology to evaluate the entire bladder in a fully noninvasive manner. It requires the anatomical bladder images be acquired at high spatial resolution and with adequate signal-to-noise ratio (SNR). This often leads to a long-time scan (>5 min) and results in image artifacts due to involuntary bladder motion and deformation. In this paper, we investigated an image-processing approach to mitigate the problem of motion and deformation. Instead of a traditional single long-time scan, six repeated short-time scans (each of approximately 1 min) were acquired for the purpose of shifting bladder motion from intrascan into interscans. Then, the interscan motions were addressed by registering the short-time scans to a selected reference and finally forming a single average motion-corrected image. To evaluate the presented approach, three types of images were generated: 1) the motion-corrected image by registration and average of the short-time scans; 2) the directly averaged image of the short-time scans (without motion correction); and 3) the single image of the corresponding long-time scan. Six experts were asked to blindly score these images in terms of two important aspects: 1) the definition of the bladder wall and 2) the overall expression on the image quality. Statistical analysis on the scores suggested that the best result in both the aspects is achieved by the presented motion-corrected average. Furthermore, the superiority of the motion-corrected average over the other two is statistically significant by the measure of a linear mixed-effect model with p -values < 0.05. Our findings may facilitate the detection of bladder abnormality in MR cystography by mitigating the motion challenge. The effectiveness of this approach depends on the noise level of acquired short-time scans and the robustness of image registration, and future effort on these two aspects is needed.
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Affiliation(s)
- Qin Lin
- College of Electronics and Information Engineering, Sichuan University, Chengdu 610064, China.
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Chernet BT, Levin M. Transmembrane voltage potential is an essential cellular parameter for the detection and control of tumor development in a Xenopus model. Dis Model Mech 2013; 6:595-607. [PMID: 23471912 PMCID: PMC3634644 DOI: 10.1242/dmm.010835] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Understanding mechanisms that orchestrate cell behavior into appropriately patterned tissues and organs within the organism is an essential element of preventing, detecting and treating cancer. Bioelectric signals (resting transmembrane voltage potential gradients in all cells) underlie an important and broadly conserved set of control mechanisms that regulate pattern formation. We tested the role of transmembrane potential in tumorigenesis mediated by canonical oncogenes in Xenopus laevis. Depolarized membrane potential (Vmem) was a characteristic of induced tumor-like structures (ITLSs) generated by overexpression of Gli1, KrasG12D, Xrel3 or p53Trp248. This bioelectric signature was also present in precursor ITLS sites. Vmem is a bioelectric marker that reveals ITLSs before they become histologically and morphologically apparent. Moreover, voltage was functionally important: overexpression of hyperpolarizing ion transporters caused a return to normal Vmem and significantly reduced ITLS formation in vivo. To characterize the molecular mechanism by which Vmem change regulates ITLS phenotypes, we performed a suppression screen. Vmem hyperpolarization was transduced into downstream events via Vmem-regulated activity of SLC5A8, a sodium-butyrate exchanger previously implicated in human cancer. These data indicate that butyrate, a histone deacetylase (HDAC) inhibitor, might be responsible for transcriptional events that mediate suppression of ITLSs by hyperpolarization. Vmem is a convenient cellular parameter by which tumors induced by human oncogenes can be detected in vivo and represents a new diagnostic modality. Moreover, control of resting membrane potential is functionally involved in the process by which oncogene-bearing cells depart from normal morphogenesis programs to form tumors. Modulation of Vmem levels is a novel and promising strategy for tumor normalization.
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Affiliation(s)
- Brook T Chernet
- Center for Regenerative and Developmental Biology and Department of Biology, Tufts University, 200 Boston Avenue, Medford, MA 02155, USA
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Agenant M, Noordmans HJ, Koomen W, Bosch JLHR. Real-time bladder lesion registration and navigation: a phantom study. PLoS One 2013; 8:e54348. [PMID: 23365663 PMCID: PMC3554768 DOI: 10.1371/journal.pone.0054348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/12/2012] [Indexed: 11/18/2022] Open
Abstract
Background Bladder cancer is the fourth most common malignancy in men, with a recurrence rate of 33–64%. Tumor documentation during cystoscopy of the bladder is suboptimal and might play a role in these high recurrence rates. Objective In this project, a bladder registration and navigation system was developed to improve bladder tumor documentation and consequently increase reproducibility of the cystoscopy. Materials/Methods The bladder registration and navigation system consists of a stereo-tracker that tracks the location of a newly developed target, which is attached to the endoscope during cystoscopy. With this information the urology registration and navigation software is able to register the 3D position of a lesion of interest. Simultaneously, the endoscopic image is captured in order to combine it with this 3D position. To enable navigation, navigational cues are displayed on the monitor, which subsequently direct the cystoscopist to the previously registered lesion. To test the system, a rigid and a flexible bladder phantom was developed. The system's robustness was tested by measuring the accuracy of registering and navigating the lesions. Different calibration procedures were compared. It was also tested whether system accuracy is limited by using a previously saved calibration, to avoid surgical delay due to calibration. Urological application was tested by comparing a rotational camera (fixed to the rotating endoscope) to a non-rotational camera (dangling by gravity) used in standard urologic practice. Finally, the influence of volume differences on registering and navigating was tested. Results/Conclusion The bladder registration and navigation system has an acceptable accuracy for bladder lesion registration and navigation. Limitations for patient determinants included changes in bladder volume and bladder deformation. In vivo studies are required to measure the effect of these limitations and functionality in urological practice as a tool to increase reproducibility of the cystoscopy.
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Affiliation(s)
- Michelle Agenant
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Ascenti G, Mileto A, Gaeta M, Blandino A, Mazziotti S, Scribano E. Single-phase dual-energy CT urography in the evaluation of haematuria. Clin Radiol 2012; 68:e87-94. [PMID: 23219453 DOI: 10.1016/j.crad.2012.11.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/31/2012] [Accepted: 11/09/2012] [Indexed: 11/26/2022]
Abstract
AIM To assess the value of a single-phase dual-energy computed tomography (DECT) urography protocol with synchronous nephrographic-excretory phase enhancement and to calculate the potential dose reduction by omitting the unenhanced scan. MATERIALS AND METHODS Eighty-four patients referred for haematuria underwent CT urography using a protocol that included single-energy unenhanced and dual-energy contrast-enhanced with synchronous nephrographic-excretory phase scans. DECT-based images [virtual unenhanced (VUE), weighted average, and colour-coded iodine overlay] were reconstructed. Opacification degree by contrast media of the upper urinary tract, and image quality of virtual unenhanced images were independently evaluated using a four-point scale. The diagnostic accuracy in detecting urothelial tumours on DECT-based images was determined. The dose of a theoretical dual-phase single-energy protocol was obtained by multiplying the effective dose of the unenhanced single-energy acquisition by two. Radiation dose saving by omitting the unenhanced scan was calculated. RESULTS The degree of opacification was scored as optimal or good in 86.9% of cases (k = 0.72); VUE image quality was excellent or good in 83.3% of cases (k = 0.82). Sensitivity, specificity, positive predictive value, and negative predictive value for urothelial tumours detection were 85.7, 98.6, 92.3, and 97.1%. Omission of the unenhanced scan led to a mean dose reduction of 42.7 ± 5%. CONCLUSION Single-phase DECT urography with synchronous nephrographic-excretory phase enhancement represents an accurate "all-in-one'' approach with a radiation dose saving up to 45% compared with a standard dual-phase protocol.
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Affiliation(s)
- G Ascenti
- Department of Radiological Sciences, Policlinico G. Martino, University of Messina, Messina, Italy
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Singh I, Mehrotra G, Jaura MS, Agarwal V, Tandon A, Joshi M. Virtual cystoscopy (pneumo-cystoscopy)-Its utility in the prospective evaluation of bladder tumor. Indian J Urol 2012; 28:164-8. [PMID: 22919131 PMCID: PMC3424892 DOI: 10.4103/0970-1591.98457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim: To evaluate the role of virtual cystoscopy (VC) comparing it with cystopanendoscopy (CPE) for detecting bladder tumor(s). Material and Methods: Ethical clearance was obtained from the Institutional ethics committee. After an informed consent 30 patients fulfilling the inclusion criteria were enrolled in the prospective non-randomized clinical study and were evaluated as per protocol with VC performed by a qualified radiologist who was blinded to the findings of CPE performed by a qualified urologist. The results so obtained were analyzed using appropriate statistical tools. Results: The mean age of the patients was 56 years. Sensitivity of VC in detecting bladder lesions was 92%. However, when axial images were also interpreted along with VC, the sensitivity increased to 96% for detecting bladder lesions. The specificity of VC with axial CT was 40% in respect of detecting bladder lesions. VC with axial CT was 85.7% sensitive in identifying multiple bladder tumors. There were no complications on account of performing VC. Minor problems were encountered with VC and CPE in 16.7% and 13.3% patients respectively. Conclusions: VC with axial CT is 96% sensitive in detecting bladder lesions and 85.7% sensitive in detecting the multiplicity of the tumors. VC may be a useful complementary diagnostic tool for the workup of select patients with suspected bladder lesions. However, larger randomized controlled studies are needed to better define the precise clinical and diagnostic role of VC in routine practice. Settings and Design: Prospective Clinical Comparative Non Randomized Clinical Study.
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Affiliation(s)
- Iqbal Singh
- Department of Surgery (Div of Urology), University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
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The diagnostic accuracy of multidetector computed tomography with multiplanar reformatted imaging and virtual cystoscopy in the early detection and evaluation of bladder carcinoma: comparison with conventional cystoscopy. ACTA ACUST UNITED AC 2012; 38:184-92. [DOI: 10.1007/s00261-012-9902-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gulsen F, Dikici S, Mihmanli I, Ozbayrak M, Onal B, Obek C, Kantarci F. Detection of bladder cancer recurrence with real-time three-dimensional ultrasonography-based virtual cystoscopy. J Int Med Res 2012; 39:2264-72. [PMID: 22289542 DOI: 10.1177/147323001103900623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This prospective study evaluated the accuracy of grey-scale two-dimensional (2D) ultrasonography and real-time threedimensional (3D) ultrasonography-based virtual cystoscopy for detecting early recurrence of bladder cancer in previously treated patients (n = 40). Real-time 3D ultrasonography-based virtual cystoscopy images were compared with both 2D ultrasonography and interval conventional cystoscopy pathology results. Ultrasound examinations were performed before routine follow-up with conventional cystoscopy. Overall sensitivity for real-time 3D ultrasonography-based virtual cystoscopy was lower than for 2D ultrasonography, indicating it did not provide additional information. The results of combined (2D and 3D) ultrasonography and conventional cystoscopy differed significantly. Where lesions were detected with combined ultrasonography, the number of previous cystoscopies was lower and the tumour stage was significantly higher at initial diagnosis, compared with cases where no lesions were detected. The results suggest that ultrasonography before cystoscopy can be performed more frequently - or, if no lesions are detected by ultrasonography, the interval between cystoscopies can be prolonged - in patients at high risk of bladder cancer recurrence.
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Affiliation(s)
- F Gulsen
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Yoon WJ, Brown MA, Reinhall PG, Park S, Seibel EJ. Design and preliminary study of custom laser scanning cystoscope for automated bladder surveillance. MINIM INVASIV THER 2012; 21:320-8. [DOI: 10.3109/13645706.2011.653374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lalondrelle S, Sohaib SA, Castellano IA, Mears D, Huddart R, Khoo V. Investigating the relationship between virtual cystoscopy image quality and CT slice thickness. Br J Radiol 2012; 85:1112-7. [PMID: 22215882 DOI: 10.1259/bjr/99567374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the effect of reconstruction slice thickness on image quality at CT virtual cystoscopy (VC). METHODS Pelvic CT examinations in bladder cancer patients were reconstructed at different slice thicknesses (0.6-5 mm) and intervals, and resulting VC images assessed. Quality indicators were ridging, holes, floaters and dimpling artefacts, tumour definition, and an overall score, ranked 1 (best) to 7 (worst). CT number and standard deviation (SD) for bladder contents and bladder wall were recorded. The mean SD was used as a measure of noise, and the contrast-to-noise ratio (CNR) was calculated as the CT number difference between them divided by the average image noise. The mean CNR across the three levels was used for analysis. Each qualitative image quality measure was compared with CT number, noise and CNR measurements. RESULTS Dimpling artefacts increased with thinner slice reconstruction and correlated with increased noise, often resulting in poor tumour definition. The best overall image quality score was seen for VC images reconstructed at 1.2 mm slice thickness, probably because of the competing effects of spatial resolution and CNR. CONCLUSION A slice thickness reconstruction <1.2 mm does not provide for better image quality at VC owing to the presence of increased noise.
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Affiliation(s)
- S Lalondrelle
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
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Hu J, Xuan X, Han C, Hao L, Zhang P, Chen M, He H, Fan T, Dong B. Anti-tumor function of double-promoter regulated adenovirus carrying SEA gene, in the treatment of bladder cancer. Cell Biochem Biophys 2011; 62:353-9. [PMID: 22002027 DOI: 10.1007/s12013-011-9289-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
To construct an adenovirus carrying SEA gene and regulated by telomerase reverse transcriptase (hTERT) and hypoxia-inducible factor (HIF) promoters and investigate its anti-tumor function in vitro, as well as its role in lymphocyte production. hTERT and HIF genes were cloned into adenovirus E1A and E1B shuttle plasmids. The control vector for SEA gene expression is under the regulation of CMV and SV40 promoters. Double regulation was obtained through homologous recombination. The positive clones of replicable adenovirus H2-SEA-Ad were selected by plaque assay. The adenovirus was purified, titrated, and DNA was verified by PCR. The obtained virus was used to infect EJ bladder tumor cells and the SEA Mrna, and protein expression was measured by RT-PCR, western blot, and immunofluorescence microscopy, respectively. Co-culture of lymphocytes and tumor cells was observed dynamically under microscope. The construction of shuttle plasmid p315-CSS-SEA was confirmed by PCR and DNA sequencing. Insertion of superantigen SEA gene in adenovirus (H2-SEA-Ad.SEA) was obtained by homologous recombination. In lymphocytes and tumor cell co-culture, the number of viable tumor cells in test groups was significantly lower than that in control group after 12, 24, and 48 h of treatment. Production of interleukin-2, interleukin-4, and tumor necrosis factor were higher in test groups than in control group. Expression of SEA gene in bladder tumor cells by adenoviral vector caused reduced tumor cell proliferation, as well as stimulation of inflammatory cytokine productions in co-cultures with lymphocytes.
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Affiliation(s)
- Jianpeng Hu
- Department of Urology, People's Hospital Affiliated to Jiangsu University, Zhenjiang 212002, China.
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Karabacak OR, Cakmakci E, Ozturk U, Demirel F, Dilli A, Hekimoglu B, Altug U. Virtual cystoscopy: the evaluation of bladder lesions with computed tomographic virtual cystoscopy. Can Urol Assoc J 2011; 5:34-7. [PMID: 21470511 DOI: 10.5489/cuaj.10002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Our objective was to assess the accuracy of computed tomographic virtual cystoscopy (CTVC) in the detection of urinary bladder lesions. METHODS Twenty-five patients were examined using CTVC. Bladder scanned using multislice CT at a slice thickness of 1 mm. The data were transferred to a workstation for interactive navigation using surface rendering. Findings obtained from CTVC were compared with results from conventional cystoscopy and with pathological findings. RESULTS Thirty-eight lesions were identified. The smallest was 0.2 × 0.3 cm; the largest was 7 × 4.5 cm. Both CTVC and conventional cystoscopy were used. Conventional cystoscopy detected the same number of lesions that were detected by CTVC. On morphological examination, 26 of the lesions were polypoid, 7 were sessile and 5 were bladder wall-thickening. While one of the polypoid lesions was reported as an inverted papilloma, 2 of the 5 lesions that were identified as wall-thickening were malignant and 3 were benign. The sensitivity of using CTVC to identify neoplasias was 100%; the accuracy was 89%. CONCLUSION Although the definitive diagnosis of some suspected urinary bladder tumours is only possible with conventional cystoscopy and biopsy, CTVC is a minimally invasive technique which provides beneficial information about urinary bladder lesions.
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Affiliation(s)
- Osman Raif Karabacak
- Ministry of Health, Ankara Dışkapı Yıldırım Beyazit Education and Research Hospital, Department of Urology, Ankara, Turkey
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Novel Approach to Segment the Inner and Outer Boundaries of the Bladder Wall in T2-Weighted Magnetic Resonance Images. Ann Biomed Eng 2011; 39:2287-97. [DOI: 10.1007/s10439-011-0324-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
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Avcu S, Koseoglu MN, Ceylan K, Bulut MD, Dbulutand M, Unal O. The value of diffusion-weighted MRI in the diagnosis of malignant and benign urinary bladder lesions. Br J Radiol 2011; 84:875-82. [PMID: 21224296 DOI: 10.1259/bjr/30591350] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the role of diffusion-weighted MRI (DWI) in the diagnosis of urinary bladder (UB) tumours by means of measuring apparent diffusion coefficient (ADC) values. METHODS A total of 83 people aged between 18 and 86 years were included in the study: 63 patients with UB pathology (46 malignant, 17 benign) constituted the case group; 20 individuals without any UB pathology constituted the control group. DWI was applied to all individuals. The ADC values were measured based on the tissue of the UB mass entities and normal UB wall in the control group. RESULTS The mean ADC value in the UB carcinoma group was significantly lower than that in the control group: 1.0684 ± 0.26 × 10(-3) mm(2) s(-1) and 2.010 ± 0.11 × 10(-3) mm(2) s(-1), respectively (p<0.01). There was a significant difference among the mean ADC values of different grades of malignant tumours, corresponding to 0.9185 ± 0.20 mm(2) s(-1) and 1.281 ± 0.18 mm(2) s(-1) in high-grade and low-grade malignant UB carcinomas, respectively (p<0.01). The ADC value in the carcinoma group was significantly lower than that in the benign lesion group: 1.0684 ± 0.26 × 10(-3) mm(2) s(-1) and 1.803 ± 0.19 × 10(-3) mm(2) s(-1), respectively (p<0.01). All 46 malignant lesions displayed a restriction in diffusion; 4 of the 17 benign lesions displayed a mild restriction in diffusion. The sensitivity, specificity and accuracy of DWI in the diagnosis of malignant UB lesions was 100%, 76.5% and 93.65%, respectively. CONCLUSION DWI can be beneficial in the differentiation of benign and malignant UB lesions, as well as of high-grade and low-grade UB carcinomas, using quantitative ADC measurements.
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Affiliation(s)
- S Avcu
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
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Qu X, Huang X, Wu L, Huang G, Ping X, Yan W. Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: a meta-analysis. Eur J Radiol 2010; 80:188-97. [PMID: 20452159 DOI: 10.1016/j.ejrad.2010.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/26/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Bladder cancer is the most commonly diagnosed malignancy in patients presenting with haematuria. Early detection is crucial for improving patient prognosis. We therefore performed a meta-analysis to evaluate and compare the detection validity (sensitivity and specificity) of virtual cystoscopy (VC) and ultrasonography (US). METHODS We searched MEDLINE, EMBASE, PubMed and the Cochrane Library for studies evaluating diagnosis validity of VC and US between January 1966 and December 2009. Meta-analysis methods were used to pool sensitivity and specificity and to construct a summary receiver-operating characteristic (SROC) curve. RESULTS A total of 26 studies that included 3084 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for bladder cancer detection using CT virtual cystoscopy (CTVC), MR virtual cystoscopy (MRVC) and US was 0.939 (95% CI, 0.919-0.956), 0.908 (95% CI, 0.827-0.959) and 0.779 (95% CI, 0.744-0.812), respectively. The pooled specificity for bladder cancer detection using CTVC, MRVC and US was 0.981 (95% CI, 0.973-0.988), 0.948 (95% CI, 0.884-0.983) and 0.962 (95% CI, 0.953-0.969), respectively. The pooled diagnostic odd ratio (DOR) estimate for CTVC (604.22) were significantly higher than for MRVC (144.35, P<0.001) and US (72.472, P<0.001). CONCLUSION Our results showed that both CTVC and MRVC are better imaging methods for diagnosing bladder cancer than US. CTVC has higher diagnostic value (sensitivity, specificity and DOR) for the detection of bladder cancer than either MRCT or US.
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Affiliation(s)
- Xinhua Qu
- Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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Duan C, Liang Z, Bao S, Zhu H, Wang S, Zhang G, Chen JJ, Lu H. A coupled level set framework for bladder wall segmentation with application to MR cystography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:903-915. [PMID: 20199924 PMCID: PMC2894540 DOI: 10.1109/tmi.2009.2039756] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this paper, we propose a coupled level set (LS) framework for segmentation of bladder wall using T(1)-weighted magnetic resonance (MR) images with clinical applications to virtual cystoscopy (i.e., MR cystography). The framework uses two collaborative LS functions and a regional adaptive clustering algorithm to delineate the bladder wall for the wall thickness measurement on a voxel-by-voxel basis. It is significantly different from most of the pre-existing bladder segmentation work in four aspects. First of all, while most previous work only segments the inner border of the wall or at most manually segments the outer border, our framework extracts both the inner and outer borders automatically except that the initial seed point is given by manual selection. Secondly, it is adaptive to T(1)-weighted images with decreased intensities in urine, as opposed to enhanced intensities in T(2)-weighted scenario and computed tomography. Thirdly, by considering the image global intensity distribution and local intensity contrast, the defined image energy function in the framework is more immune to inhomogeneity effect, motion artifacts and image noise. Finally, the bladder wall thickness is measured by the length of integral path between the two borders which mimic the electric field line between two iso-potential surfaces. The framework was tested on six datasets with comparison to the well-known Chan-Vese (C-V) LS model. Five experts blindly scored the segmented inner and outer borders of the presented framework and the C-V model. The scores demonstrated statistically the improvement in detecting the inner and outer borders.
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Affiliation(s)
- Chaijie Duan
- Beijing Key Lab of Medical Physics and Engineering, Peking University, Beijing 100871, China
- Department of Radiology, State University of New York, Stony Brook, NY 11794, USA
| | - Zhengrong Liang
- Department of Radiology, State University of New York, Stony Brook, NY 11794, USA
| | - Shangliang Bao
- Beijing Key Lab of Medical Physics and Engineering, Peking University, Beijing 100871, China
| | - Hongbin Zhu
- Department of Radiology, State University of New York, Stony Brook, NY 11794, USA
| | - Su Wang
- Department of Radiology, State University of New York, Stony Brook, NY 11794, USA
| | - Guangxiang Zhang
- Department of Preventive Medicine, State University of New York, Stony Brook, NY 11794, USA
| | - John J. Chen
- Department of Preventive Medicine, State University of New York, Stony Brook, NY 11794, USA
| | - Hongbing Lu
- Department of Biomedical Engineering/Computer Application, Fourth Military Medical University, Xi’an, Shaanxi 710032, China
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Diagnostic Efficiency of Multidetector Computed Tomography With Multiplanar Reformatted Imaging and Virtual Cystoscopy in the Assessment of Bladder Tumors After Transurethral Resection. J Comput Assist Tomogr 2010; 34:121-6. [DOI: 10.1097/rct.0b013e3181b728ae] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Sixteen-Slice Multidetector Computed Tomographic Virtual Cystoscopy in the Evaluation of a Patient With Suspected Bladder Tumor and History of Bladder Carcinoma Operation. J Comput Assist Tomogr 2009; 33:867-71. [DOI: 10.1097/rct.0b013e318199d6da] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Abstract
Driven by major improvements in high resolution MR imaging 3D reconstructions and virtual endoscopy based on MRI have become possible. This article describes basic MR imaging techniques for 3D reconstructions. Principles of MRI-based virtual endoscopy are explained. Different 3D rendering methods are mentioned and discussed. Finally, clinical applications for MRI-based virtual endoscopy are described.
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Abstract
OBJECTIVE The purpose of this article is to review the epidemiology, staging, and treatment of bladder cancer; to discuss the role of MDCT urography for the evaluation of patients with known or suspected bladder cancer; and to address the role of MDCT urography in patients who require follow-up imaging after a diagnosis of bladder cancer has been made. CONCLUSION MDCT urography now has a large role in the evaluation of patients with known and suspected bladder cancer. However, its precise role has not been established. Because many bladder neoplasms will not be detected by MDCT urography and more research is needed to determine the optimal technique for diagnosing bladder cancer, we think that MDCT urography cannot replace cystoscopy at present.
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37
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Bladder carcinoma: MDCT cystography and virtual cystoscopy. ACTA ACUST UNITED AC 2009; 35:257-64. [DOI: 10.1007/s00261-009-9530-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 04/20/2009] [Indexed: 11/26/2022]
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Nicolau C, Bunesch L, Sebastia C, Salvador R. Diagnosis of bladder cancer: contrast-enhanced ultrasound. ACTA ACUST UNITED AC 2009; 35:494-503. [PMID: 19458995 DOI: 10.1007/s00261-009-9540-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 04/30/2009] [Indexed: 01/29/2023]
Affiliation(s)
- Carlos Nicolau
- Imaging Diagnosis Center, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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39
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Igarashi T, Suzuki H, Naya Y. Computer-based endoscopic image-processing technology for endourology and laparoscopic surgery. Int J Urol 2009; 16:533-43. [DOI: 10.1111/j.1442-2042.2009.02258.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Croitoru S, Moskovitz B, Nativ O, Barmeir E, Hiller N. Diagnostic potential of virtual pneumoendoscopy of the urinary tract. ACTA ACUST UNITED AC 2009; 33:717-23. [PMID: 18172706 DOI: 10.1007/s00261-007-9346-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the diagnostic possibilities of CT virtual pneumoendoscopy, in various vesical and extra-vesical urinary tract abnormalities and suggest possible indications for this examination. PATIENTS AND METHODS Thirty-three patients (26 men and 7 women, aged 30-91, mean-61 years) were referred by the urologists for specific further evaluation of the urinary tract with virtual pneumoendoscopy for various indications. All patients except three underwent conventional endoscopy within a week either before or after the virtual examination, but the endoscopy was either equivocal or limited. The urinary tract was insufflated with room air. RESULTS Successful CT pneumoendoscopy was achieved in 31 of the 33 patients. The indications for the virtual study included obstructive uropathy (22), hematuria (15), and suspected fistula (2). The virtual examination findings included urethral stricture, recto-urethral fistula, multiple bladder tumors, bladder tumor invading the distal ureter or urethra, bladder diverticula containing a tumor, ureteral stricture, renal transitional cell carcinoma, and renal calculi with inflammation. Virtual CT endoscopy had added value to the diagnostic process in all our patients. CONCLUSION In selected cases virtual CT pneumoendoscopy may serve as an important adjunctive diagnostic aid for urologic pathologies.
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Yoon WJ, Park S, Reinhall PG, Seibel EJ. Development of an Automated Steering Mechanism for Bladder Urothelium Surveillance. J Med Device 2009; 3:11004. [PMID: 20011075 DOI: 10.1115/1.3054381] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Given the advantages of cystoscopic exams compared with other procedures available for bladder surveillance, it would be beneficial to develop an improved automated cystoscope. We develop and propose an active programmable remote steering mechanism and an efficient motion sequence for bladder cancer detection and postoperative surveillance. The continuous and optimal path of the imaging probe can enable a medical practitioner to readily ensure that images are produced for the entire surface of the bladder in a controlled and uniform manner. Shape memory alloy (SMA) based segmented actuators disposed adjacent to the distal end of the imaging probe are selectively activated to bend the shaft to assist in positioning and orienting the imaging probe at a plurality of points selected to image all the interior of the distended bladder volume. The bending arc, insertion depth, and rotational position of the imaging probe are automatically controlled based on patient-specific data. The initial prototype is tested on a 3D plastic phantom bladder, which is used as a proof-of-concept in vitro model and an electromagnetic motion tracker. The 3D tracked tip trajectory results ensure that the motion sequencing program and the steering mechanism efficiently move the image probe to scan the entire inner tissue layer of the bladder. The compared experimental results shows 5.1% tip positioning error to the designed trajectory given by the simulation tool. The authors believe that further development of this concept will help guarantee that a tumor or other characteristic of the bladder surface is not overlooked during the automated cystoscopic procedure due to a failure to image it.
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Affiliation(s)
- W Jong Yoon
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195,
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42
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Identification of Nodal Metastases: The role of Iron Oxide Enhanced MRI. Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kivrak A, Kiresi D, Emlik D, Odev K, Kilinc M. Comparison of CT virtual cystoscopy of the contrast material-filled bladder with conventional cystoscopy in the diagnosis of bladder tumours. Clin Radiol 2009; 64:30-7. [DOI: 10.1016/j.crad.2008.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 05/05/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
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64-detector row CT cystography with virtual cystoscopy in the detection of bladder carcinoma: preliminary experience in selected patients. Radiol Med 2008; 114:52-69. [DOI: 10.1007/s11547-008-0350-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
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Lopes RI, Nogueira L, Albertotti CJ, Takahashi DY, Lopes RN. Comparison of Virtual Cystoscopy and Transabdominal Ultrasonography with Conventional Cystoscopy for Bladder Tumor Detection. J Endourol 2008; 22:1725-9. [PMID: 18657034 DOI: 10.1089/end.2007.0363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Lucienne Nogueira
- Sociedade Beneficente de Senhoras Hospital Sírio Libanês, São Paulo, Brazil
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Scardapane A, Pagliarulo V, Ianora AAS, Pagliarulo A, Angelelli G. Contrast-enhanced multislice pneumo-CT-cystography in the evaluation of urinary bladder neoplasms. Eur J Radiol 2008; 66:246-52. [PMID: 17629431 DOI: 10.1016/j.ejrad.2007.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 05/08/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the accuracy of contrast-enhanced multislice CT (MSCT) in the study of urothelial tumors after distension of the bladder with air. MATERIALS AND METHODS We evaluated 43 consecutive patients with endoscopically proven bladder lesions. After air distension of the bladder, unenhanced pelvic and enhanced abdomino-pelvic scans were obtained with the following protocol: thickness 2.5mm x 4mm, increment 1mm, scan delay 40'' and 7-10 min. For each patient we considered the number, size, aspect (papillary or sessile) and contrast enhancement of lesions. Ureteral involvement and the presence of synchronous lesions in the excretory scan were also evaluated. MPR and virtual endoscopy images were reviewed in all cases. RESULTS Bladder lesions were visualized in 39/43 cases. Compared to conventional cystoscopy, MSCT recognized single lesions in 31/33 patients, two lesions in 4/6, three in 2/2 and more than five foci in 2/2 patients. A papillary aspect was described in 44 cases while 11 lesions were sessile. Conventional Cystoscopy recognized six more lesions as compared with MSCT (four flat and two small papillary lesions). The detection rate for protruding lesions was 100% (52/52) for lesions>5mm and 60% (3/5%) for lesions<5mm. In four patients hydronephrosis was present, while in one case a synchronous lesion was evident in the renal pelvis. CONCLUSION Contrast-enhanced MSCT with air distension of the urinary bladder is a safe and complete investigation to evaluate the local stage of bladder cancer and to evaluate the ureteral extension of the tumor, as well as the presence of synchronous lesions.
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Affiliation(s)
- Arnaldo Scardapane
- Institute of Diagnostic Radiology, University Hospital, Policlinico, Bari, Italy.
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47
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16-MDCT Cystoscopy in the Evaluation of Neoplasms of the Urinary Bladder. AJR Am J Roentgenol 2008; 190:729-35. [DOI: 10.2214/ajr.07.3054] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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48
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Kocakoc E, Kiris A, Orhan I, Poyraz AK, Artas H, Firdolas F. Detection of bladder tumors with 3-dimensional sonography and virtual sonographic cystoscopy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:45-53. [PMID: 18096730 DOI: 10.7863/jum.2008.27.1.45] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Bladder tumors are among the most common types of malignant neoplasms of the urinary tract. The purpose of this study was to evaluate the potential value of 3-dimensional (3D) sonography and sonographic cystoscopy in detection of bladder tumors. METHODS Thirty-one patients with suspected or known bladder tumors were included this study. All patients underwent 3D sonography and conventional cystoscopy within 15 days. The number, size, location, and morphologic features of the lesions were evaluated on gray scale, 3D virtual, and multiplanar reconstruction images obtained from the patients. The results of 3D sonographic cystoscopy were compared with the findings from conventional cystoscopy, which was considered the reference standard. RESULTS Twenty-eight (90.3%) of 31 3D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22 of 28 patients; 3D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. Three-dimensional virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a positive predictive value of 93.9%, and a negative predictive value of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a positive predictive value of 97.6%, and a negative predictive value of 84.2% for tumor detection. CONCLUSIONS Three-dimensional sonography is a promising alternative noninvasive technique for use in detection of bladder tumors, their localization, and perivesical spreading. The location, size, and morphologic features of the tumors shown on 3D sonography agreed well with the findings of conventional cystoscopy.
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Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Faculty of Medicine, Firat University, 23119, Elazig, Turkey.
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49
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Genitourinary Imaging. Oncology 2007. [DOI: 10.1007/0-387-31056-8_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Park SB, Kim JK, Lee HJ, Choi HJ, Cho KS. Hematuria: portal venous phase multi detector row CT of the bladder--a prospective study. Radiology 2007; 245:798-805. [PMID: 17951346 DOI: 10.1148/radiol.2452061060] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively determine the accuracy of portal venous phase helical multi-detector row computed tomography (CT) for bladder lesion evaluation in patients with hematuria by using cystoscopy as the reference standard. MATERIALS AND METHODS The study was approved by the institutional review board for human investigation, and informed consent was obtained from all patients. This study included 118 patients (91 male, 27 female; age range, 15-87 years; mean age +/- standard deviation, 62 years +/- 14) who underwent portal venous phase multi-detector row CT (scanning delay, 70 seconds; section thickness, 2 mm) and conventional cystoscopy because of painless gross hematuria or recurrent microscopic hematuria. Two reviewers with different experience levels independently evaluated the bladder for lesions at CT in a prospective fashion. The kappa statistic was used to determine the per lesion and per patient agreement between the two reviewers and between the CT and cystoscopic findings. The sensitivity and specificity of multi-detector row CT for bladder lesion detection were analyzed for numbers of lesions and for numbers of patients. RESULTS Multi-detector row CT showed excellent per lesion (kappa = 0.839) and per patient (kappa = 0.881) agreement between the two reviewers. Respective per lesion and per patient agreement between the CT and cystoscopic findings was also excellent in the first (kappa = 0.866 and kappa = 0.881) and second (kappa = 0.802 and kappa = 0.863) reviewers. The sensitivity and specificity of multi-detector row CT were 89%-92% and 88%-97%, respectively, in the per lesion analysis and 95% and 91%-93%, respectively, in the per patient analysis for both reviewers. All statistical parameters of diagnostic accuracy were similar between the two reviewers (P > .05). CONCLUSION Portal venous phase multi-detector row CT can provide high accuracy and reader agreement for bladder lesion detection in patients with painless gross hematuria and recurrent microscopic hematuria; these results indicate that multi-detector row CT can be used as the initial bladder examination in such patients.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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