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Takeuchi M, Tamada T, Higaki A, Kojima Y, Ueno Y, Yamamoto A. Pictorial review of the diagnosis of muscle-invasive bladder cancer using vesical imaging-reporting and data system (VI-RADS). Abdom Radiol (NY) 2024:10.1007/s00261-024-04424-3. [PMID: 38900320 DOI: 10.1007/s00261-024-04424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
The Vesical Imaging-Reporting and Data System (VI-RADS) is a standard magnetic resonance imaging (MRI) and diagnostic method for muscle-invasive bladder cancer that was published in 2018. Several studies have demonstrated that VI-RADS has high diagnostic power and reproducibility. However, reading VI-RADS requires a certain amount of expertise, and radiologists need to be aware of the various pitfalls. MRI of the bladder includes T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCEI). T2WI is excellent for understanding anatomy. DWI and DCEI show high contrast between the tumor and normal anatomical structures and are suitable for staging local tumors. Bladder tumors are classified into five categories according to their size and morphology and their positional relationship to the bladder wall based on the VI-RADS diagnostic criteria. If the T2WI, DWI, and DCEI categories are the same, the category is the VI-RADS category. If the categories do not match, the DWI category is the VI-RADS category. If image quality of DWI is not evaluable, the DCEI category is the final category. In many cases, DWI is dominant, but this does not mean that T2WI and DCEI can be omitted from the reading of the bladder. In this educational review, typical and atypical teaching cases are demonstrated, and how to resolve misdiagnosis and the limitations of VI-RADS are discussed. The most important aspect of VI-RADS reading is to practice multiparametric reading with a solid understanding of the characteristics and role of each sequence and an awareness of the various pitfalls.
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Affiliation(s)
- Mitsuru Takeuchi
- Department of Radiology, Radiolonet Tokai, 3-86-2, Asaoka-Cho, Chikusa-Ku, Nagoya, Aichi, 464-0811, Japan.
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan.
| | - Tsutomu Tamada
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Atsushi Higaki
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Yuichi Kojima
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Akira Yamamoto
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
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Jin P, Yang L, Liu Y, Huang J, Wang X. Quantitative differentiation of non-invasive bladder urothelial carcinoma and inverted papilloma based on CT urography. BMC Urol 2024; 24:73. [PMID: 38532363 DOI: 10.1186/s12894-024-01459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/17/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE To investigate the value of CT urography (CTU) indicators in the quantitative differential diagnosis of bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB). MATERIAL AND METHODS The clinical and preoperative CTU imaging data of continuous 103 patients with histologically confirmed BUC or IPB were retrospectively analyzed. The imaging data included 6 qualitative indicators and 7 quantitative measures. The recorded clinical information and imaging features were subjected to univariate and multivariate logistic regression analysis to find independent risk factors for BUC, and a combined multi-indicator prediction model was constructed, and the prediction model was visualized using nomogram. ROC curve analysis was used to calculate and compare the predictive efficacy of independent risk factors and nomogram. RESULTS Junction smoothness, maximum longitudinal diameter, tumor-wall interface and arterial reinforcement rate were independent risk factors for distinguishing BUC from IPB. The AUC of the combined model was 0.934 (sensitivity = 0.808, specificity = 0.920, accuracy = 0.835), and its diagnostic efficiency was higher than that of junction smoothness (AUC=0.667, sensitivity = 0.654, specificity = 0.680, accuracy = 0.660), maximum longitudinal diameter (AUC=0.757, sensitivity = 0.833, specificity = 0.604, accuracy = 0.786), tumor-wall interface (AUC=0.888, sensitivity = 0.755, specificity = 0.808, accuracy = 0.816) and Arterial reinforcement rate (AUC=0.786, sensitivity = 0.936, specificity = 0.640, accuracy = 0.864). CONCLUSION Above qualitative and quantitative indicators based on CTU and the combination of them may be helpful to the differential diagnosis of BUC and IPB, thus better assisting in clinical decision-making. KEY POINTS 1. Bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB) exhibit similar clinical symptoms and imaging presentations. 2. The diagnostic value of CT urography (CTU) in distinguishing between BUC and IPB has not been documented. 3. BUC and IPB differ in lesion size, growth pattern and blood supply. 4. The diagnostic efficiency is optimized by integrating multiple independent risk factors into the prediction model.
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Affiliation(s)
- Pengfei Jin
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1# Banshan East Road, Hangzhou, 310022, China
| | - Liqin Yang
- Department of Radiology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yitao Liu
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1# Banshan East Road, Hangzhou, 310022, China
| | - Jiehui Huang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1# Banshan East Road, Hangzhou, 310022, China
| | - Xu Wang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1# Banshan East Road, Hangzhou, 310022, China.
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Hoegger MJ, Strnad BS, Ballard DH, Siegel CL, Shetty AS, Weimholt RC, Yano M, Stanton ML, Mellnick VM, Kawashima A, Zulfiqar M. Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e220034. [PMID: 36490210 DOI: 10.1148/rg.220034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Benjamin S Strnad
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - R Cody Weimholt
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Melissa L Stanton
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Akira Kawashima
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
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Liu L, Zhao Y, Cui J, Chen S, Shi B. Evaluation of platelet distribution width as a diagnostic and prognostic biomarker in bladder neoplasm. Future Oncol 2019; 15:3797-3807. [PMID: 31532234 DOI: 10.2217/fon-2019-0441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: To evaluate the role of preoperative platelet distribution width (PDW) as a potential biomarker for distinguishing malignancy and tumor advantage of bladder neoplasm. Methods: The study included 210 subjects with bladder cancer, 76 subjects with urothelial papilloma and 132 healthy control subjects. Preoperative PDW along with other blood indices was evaluated. Results: PDW was higher in urothelial papilloma patients than that in bladder cancer patients (p < 0.001). Bladder cancer patients with advanced-stage disease exhibited lower PDW levels compared with patients with early stage disease. Conclusion: Reduced preoperative PDW level is an indicator of malignancy and advanced bladder cancer stages, suggesting it as a potential biomarker in bladder cancer diagnosis and prognosis.
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Affiliation(s)
- Lei Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yajing Zhao
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Jianfeng Cui
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
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Sweeney MK, Rais-Bahrami S, Gordetsky J. Inverted urothelial papilloma: A review of diagnostic pitfalls and clinical management. Can Urol Assoc J 2017; 11:66-69. [PMID: 28443149 DOI: 10.5489/cuaj.4136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Inverted urothelial papilloma (IUP) is a rare, non-invasive endophytic lesion that accounts for 1-2% of urothelial tumours. On cystoscopy, IUP appears as a pedunculated/papillary mass with a smooth surface. On microscopy, IUP has an endophytic growth pattern with the bulk of the tumour covered by a superficial layer of urothelium, which can be hyperplastic or attenuated. The cytology should be bland, with uniform, spindled cells arranged in anastomosing trabeculae and cords with peripheral palisading of basaloid cells. Exophytic papillae and mitotic activity should be absent or focal. Pseudoglandular spaces and squamous metaplasia may also be present. There are distinct molecular differences between IUP and urothelial carcinoma (UC). IUP rarely has mutations of FGFR3, homozygous loss of 9p21, or gain of chromosomes 3, 7, and 17, whereas these mutations are frequently seen in UC. In addition, IUP is much less likely to have TERT mutations compared to UC. Immunohistochemistry can also be helpful in distinguishing the two entities as IUP is typically negative for CK20 and has a low Ki-67 proliferation index. Positivity for p53 may be seen in a minority of IUP. IUP can recur and be seen in association with UC. Distinguishing IUP from UC can be difficult due to the similarity between the two entities both on cystoscopy and histology, as up to 25% of UCs will also have inverted growth. Given the morphologic variants of IUP and UC, it is possible for a diagnostic error to occur, which can significantly impact patient management.
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Affiliation(s)
| | | | - Jennifer Gordetsky
- Department of Urology.,Department of Pathology; University of Alabama at Birmingham, Birmingham, AL, United States
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