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Almås B, Reisæter LAR, Markhus CE, Hjelle KM, Børretzen A, Beisland C. A preoperative magnetic resonance imaging can aid in staging and treatment choice for upper tract urothelial carcinoma. BJUI COMPASS 2024; 5:476-482. [PMID: 38751955 PMCID: PMC11090765 DOI: 10.1002/bco2.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives The aim was to investigate the predictive abilities of a preoperative diffusion-weighted MRI (dwMRI) among patients with surgically treated upper tract urothelial carcinoma (UTUC). Materials and methods Written consent was obtained from all participants in this prospective and ethically approved study. Thirty-five UTUC patients treated with radical surgery were examined with a preoperative dwMRI and prospectively included during 2017-2022. Two radiologists examined the CT scans and dwMRIs for radiological stage, and the apparent diffusion coefficient (ADC) in the tumours at the dwMRI was registered. The radiologists were blinded for patient history, final histopathology and the readings of the other radiologist. The radiological variables were analysed regarding their abilities to predict muscle-invasive disease (MID, T2-T4) and tumour grade at final pathology after radical surgery. The predictive abilities were assessed using chi-square tests, Student's t-test and calculating the area under the curve in a receiver operating characteristic (ROC) curve. Correlation between the two radiologists was quantified calculating the intra-class correlation coefficient. P-values <0.05 were considered statistically significant. Results Mean age was 72 years, 20 had high-grade tumour, and 13 patients had MID. The ADC values at the dwMRI were significantly lower among patients with MID compared to patients with non-muscle-invasive disease (930 vs 1189, p = <0.001). The area under the ROC curve (AUC) in an ROC curve to predict MID was 0.88 (CI 0.77-0.99, p = <0.001). The ADC values were significantly lower among patients with high-grade tumours compared to low-grade tumours (1005 vs 1210, p = 0.002). The correlation of the ADC measurements between the two radiologists was of 0.93 (CI 0.85-0.96, p < 0.001). Conclusion Tumour ADC at the MRI emerges as a potential biomarker for aggressive disease. The results are promising but should be validated in a larger, multicentre study.
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Affiliation(s)
- Bjarte Almås
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | | | | | - Karin Margrethe Hjelle
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Astrid Børretzen
- Department of PathologyHaukeland University HospitalBergenNorway
| | - Christian Beisland
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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Zhang B, Li J, Wu Z, Li C, Sun T, Zhuo N, Liang J, Duan Q, Hu H, Tian J. Contrast-Enhanced Ultrasound Characteristics of Renal Pelvis Urothelial Carcinoma and Its Relationship with Microvessel Density. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:236-243. [PMID: 33158635 DOI: 10.1016/j.ultrasmedbio.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
We studied the characteristics of contrast-enhanced ultrasound (CEUS) in renal pelvic urothelial carcinomas and explored its performance in assessing microvessel density (MVD) of tumor tissues. We retrospectively analyzed the characteristics of 125 cases, which were confirmed pathologically to be renal pelvic urothelial carcinomas using CEUS. We performed CEUS and found that most tumors presented with an enhanced mode of "slow-in (mean = 16.7 ± 2.6 s, range: 12-25 s), hypo-enhancement and fast-out (mean = 69.3 ± 16.2 s, range: 42-113 s)." However, the wash-in pattern, homogeneity and wash-out pattern observed with CEUS was not correlated with pT stage and grade (p > 0.05). But advanced-pT-stage and high-grade tumors had a higher peak enhancement than early-pT-stage and low-grade tumors (p < 0.01). Peak enhancement obtained with CEUS can be used to evaluate the pT stage and grade of renal pelvic urothelial carcinomas more effectively. The MVD of those tissues was observed using immunohistochemical staining of cluster of differentiation 34 (CD34). MVD in the advanced-pT-stage and high-grade groups was significantly higher than that in the early-pT-stage and low-grade groups (p < 0.01). As tumor pT stage and grade improved, CEUS peak enhancement intensity and MVD of tumors also exhibited an upward trend. CEUS peak enhancement intensity has the potential to determine MVD of renal pelvic urothelial carcinomas.
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Affiliation(s)
- Bo Zhang
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jing Li
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhouliang Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chenyun Li
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Sun
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Na Zhuo
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jixiang Liang
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Duan
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hailong Hu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jing Tian
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
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Honda Y, Nakamura Y, Teishima J, Goto K, Higaki T, Narita K, Akagi M, Terada H, Kaichi Y, Fujii S, Hayashi T, Matsubara A, Sentani K, Yasui W, Iida M, Awai K. Clinical staging of upper urinary tract urothelial carcinoma for T staging: Review and pictorial essay. Int J Urol 2019; 26:1024-1032. [PMID: 31379021 DOI: 10.1111/iju.14068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
Abstract
Upper urinary tract urothelial carcinoma is staged using the TNM classification of malignant tumors. Preoperative TNM is important for treatment planning. Computed tomography urography is now widely used for clinical survey of upper urinary tract carcinoma because of its diagnostic accuracy. Computed tomography urography is recommended as the first-line imaging procedure in several guidelines. Several reports stated that computed tomography urography is also useful for staging. However, no educational and practical reviews detailing the T staging of upper urinary tract urothelial carcinomas using imaging are available. We discuss the scanning protocol, T staging using computed tomography urography, limitations, magnetic resonance imaging, computed tomography comparison and pitfalls in imaging of upper urinary tract urothelial carcinoma. A recent study reported the high diagnostic accuracy of computed tomography urography with respect to T3 or higher stage tumors. To date, images that show a Tis-T2 stage have not been reported, but various studies are ongoing. Although magnetic resonance imaging has lower spatial resolution than computed tomography urography, magnetic resonance imaging can be carried out without radiation exposure or contrast agents. Magnetic resonance imaging also offers the unique ability of diffusion-weighted imaging without contrast agent use. Some researchers reported that diffusion-weighted imaging is useful not only for detecting lesions, but for predicting the T stage and tumor grade. We recommend the appropriate use of computed tomography and magnetic resonance while considering the limitations of each modality and the pitfalls in upper urinary tract urothelial carcinoma imaging.
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Affiliation(s)
- Yukiko Honda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Higaki
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keigo Narita
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motonori Akagi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Terada
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoko Kaichi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinsuke Fujii
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Usefulness of the inchworm sign on DWI for predicting pT1 bladder cancer progression. Eur Radiol 2019; 29:3881-3888. [PMID: 30888482 DOI: 10.1007/s00330-019-06119-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the significance of the presence or absence of an "inchworm sign" on DWI for the recurrence and progression of T1 bladder cancer. MATERIALS AND METHODS We retrospectively analyzed 91 patients with pT1 urothelial carcinoma who underwent DWI prior to transurethral resection between 2007 and 2016. DWI of the dominant tumors was scrutinized for inchworm signs at b = 1000 s/mm2. The association of the presence of the inchworm sign with progression and recurrence was analyzed; progression was defined as recurrence to stage T2 or higher and/or N+, and/or M1. RESULTS An inchworm sign was seen in 65 cases (71%), while it was absent in 26 cases. Among the 65, 25 (38%) had confirmed tumor recurrence, while in the remaining 26, 14 (54%) had confirmed recurrence (median time post TURB = 7.9 and 10.1 months for each). At the time of recurrence, the tumor had progressed in one (2%) inchworm-sign-positive and seven (27%) inchworm-sign-negative cases. The progression rate of inchworm-sign-negative cases was significantly higher than that of inchworm-sign-positive cases (hazard ratio = 17.2, p = 0.0017), whereas there was no significant difference in the recurrence rate between two groups. The absence of an inchworm sign and histological grade 3 were independent risk factors for progression (p < 0.001 and 0.010, respectively). CONCLUSIONS The absence of an inchworm sign on DWI was a significant prognostic factor for progression of T1 bladder cancer. Morphological evaluation of DWI signals may therefore be a useful adjunct to preoperative assessment of biological aggressiveness. KEY POINTS • An inchworm sign is a simple diagnostic criterion that characterizes only the shape of the tumor signal on DWI, and potentially serves as an imaging biomarker to predict clinical aggressiveness. • The absence of an inchworm sign on DWI is a significant indicator of progression of T1 bladder cancer.
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Marco-Rius I, Gordon JW, Mattis AN, Bok R, Santos RD, Sukumar S, Larson PE, Vigneron DB, Ohliger MA. Diffusion-weighted imaging of hyperpolarized [ 13 C]urea in mouse liver. J Magn Reson Imaging 2018; 47:141-151. [PMID: 28419644 PMCID: PMC5645231 DOI: 10.1002/jmri.25721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/16/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare the apparent diffusion coefficient (ADC) of hyperpolarized (HP) [13 C,15 N]urea to the ADC of endogenous water in healthy and fibrotic mouse liver. MATERIALS AND METHODS ADC measurements for water and [13 C]urea were made in agarose phantoms at 14.1T. Next, the ADC of water and injected HP [13 C,15 N]urea were measured in eight CD1 mouse livers before and after induction of liver fibrosis using CCl4 . Liver fibrosis was quantified pathologically using the modified Brunt fibrosis score and compared to the measured ADC of water and urea. RESULTS In cell-free phantoms with 12.5% agarose, water ADC was nearly twice the ADC of urea (1.93 × 10-3 mm2 /s vs. 1.00 × 10-3 mm2 /s). The mean ADC values of water and [13 C,15 N]urea in healthy mouse liver (±SD) were nearly identical [(0.75 ± 0.11) × 10-3 mm2 /s and (0.75 ± 0.22) × 10-3 mm2 /s, respectively]. Mean water and [13 C,15 N]urea ADC values in fibrotic liver (±SD) were (0.84 ± 0.22) × 10-3 mm2 /s and (0.75 ± 0.15) × 10-3 mm2 /s, respectively. Neither water nor urea ADCs were statistically different in the fibrotic livers compared to baseline (P = 0.14 and P = 0.99, respectively). Water and urea ADCs were positively correlated at baseline (R2 = 0.52 and P = 0.045) but not in fibrotic livers (R2 = 0.23 and P = 0.23). CONCLUSION ADC of injected hyperpolarized urea in healthy liver reflects a smaller change as compared to free solution than ADC of water. This may reflect differences in cellular compartmentalization of the two compounds. No significant change in ADC of either water or urea were observed in relatively mild stages of liver fibrosis. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:141-151.
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Affiliation(s)
- Irene Marco-Rius
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Jeremy W. Gordon
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Aras N. Mattis
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
- UCSF Liver Center University of California San Francisco, San Francisco, California, USA
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Romelyn Delos Santos
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Subramanian Sukumar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Peder E.Z. Larson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UCSF Liver Center University of California San Francisco, San Francisco, California, USA
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UCSF Liver Center University of California San Francisco, San Francisco, California, USA
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Sung Tae H, Deuk Jae S, Kyung Sook Y, Ki Choon S, Na Yeon H, Beom Jin P, Min Ju K, Sung Bum C. Prediction of high-grade ureteral urothelial carcinoma on CT urography. Br J Radiol 2017; 90:20170159. [PMID: 28830196 PMCID: PMC5853351 DOI: 10.1259/bjr.20170159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate the correlation between CT urography (CTU) findings and histological grade of ureteral urothelial carcinoma (UUC), and to identify predictors of high-grade UUC. Methods: CTU images of 73 patients with pathologically proven UUC via nephroureterectomy were independently reviewed by two radiologists for tumour size, tumour location, hydronephrosis grade, periureteral infiltration, presence of enlarged retroperitoneal lymph nodes and tumour enhancement value. Interobserver agreement was assessed with kappa statistics. Histological grade was classified as either low or high according to the WHO 2004 classification system and pathologic T stage was assessed according to the TNM staging system. Binary logistic regression, Spearman correlation analysis and receiver operating characteristic curves were used to evaluate relationships between CTU findings and histological grade. Results: 58 patients had high-grade UUCs and 15 had low-grade UUCs. Among CTU features, only hydronephrosis grade was significantly correlated with high tumour grade for both readers (p < 0.001). Multivariate logistic regression revealed that hydronephrosis of Grade 3 or higher was a significantly independent predictor of high-grade UUC for both readers (p ≤ 0.004). Interobserver agreement was excellent for hydronephrosis grade (к = 0.862). With the cut-off value of hydronephrosis Grade 3, the sensitivity, specificity and area under the curve for predicting high-grade UUC were, respectively, 88%, 79% and 0.830 for reader 1 and 86%, 80% and 0.763 for reader 2. Conclusion: Hydronephrosis of Grade 3 or higher on CTU may be predictive of high-grade UUC. Advances in knowledge: Radical surgery should be considered for UUC causing hydronephrosis of Grade 3 or higher on CTU, even in small tumours without periureteral infiltration.
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Affiliation(s)
- Hwang Sung Tae
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sung Deuk Jae
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yang Kyung Sook
- 2 Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Sim Ki Choon
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Han Na Yeon
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Park Beom Jin
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kim Min Ju
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Cho Sung Bum
- 1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Abstract
Multiparametric MR imaging (mpMRI) combine different sequences that, properly tailored, can provide qualitative and quantitative information about the tumor microenvironment beyond traditional tumor size measures and/or morphologic assessments. This article focuses on mpMRI in the evaluation of urogenital tract malignancies by first reviewing technical aspects and then discussing its potential clinical role. This includes insight into histologic subtyping and grading of renal cell carcinoma and assessment of tumor response to targeted therapies. The clinical utility of mpMRI in the staging and grading of ureteral and bladder tumors is presented. Finally, the evolving role of mpMRI in prostate cancer is discussed.
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