Abstract
INTRODUCTION: Treatment of muscle-invasive bladder cancer with chemotherapy results in haemorrhagic inflammation, mimicking residual tumour on conventional MR images and making interpretation difficult. The aim of this study was to use dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to estimate descriptive and tracer kinetic parameters post-neoadjuvant chemotherapy and to investigate whether parameters differed in areas of residual tumour and chemotherapy-induced haemorrhagic inflammation (treatment effect, Tr-Eff).
METHODS AND MATERIALS: Twenty-one patients underwent DCE-MRI scans with 2.5s temporal resolution before and following neoadjuvant chemotherapy. Regions-of-interest (ROIs) were defined in areas suspicious of residual tumour on T2-weighted MRI scans. Data were analysed semi-quantitatively and with a two-compartment exchange model to obtain parameters including relative signal intensity (rSI80s) and plasma perfusion (Fp) respectively. The bladder was subsequently examined histologically after cystectomy for evidence of residual tumour and/or Tr-Eff. Differences in parameters measured in areas of residual tumour and Tr-Eff were examined using Student's t-test.
RESULTS: Twenty-four abnormal sites were defined after neoadjuvant chemotherapy. On pathology, 10 and 14 areas were identified as residual tumour and Tr-Eff respectively. Median rSI80s and Fp were significantly higher in areas of residual tumour than Tr-Eff (rSI80s = 2.9 vs 1.7, p < 0.001; Fp = 20.7 vs 9.1 ml/100ml/min, p = 0.03). The sensitivity and specificity for differentiating residual tumour from Tr-Eff were 70% and 100% (rSI80s), 60% and 86% (Fp), and 75% and 100% when combined.
CONCLUSION: DCE-MRI parameters obtained post-treatment are capable of distinguishing between residual tumour and treatment effect in patients treated for bladder cancer with neoadjuvant chemotherapy.
Original language | English |
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Pages (from-to) | 2161-8 |
Number of pages | 8 |
Journal | European Journal of Radiology |
Volume | 82 |
Issue number | 12 |
DOIs | |
Publication status | Published - Dec 2013 |
Keywords / Materials (for Non-textual outputs)
- Aged
- Carcinoma, Transitional Cell
- Chemotherapy, Adjuvant
- Contrast Media
- Diagnosis, Differential
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Muscle Neoplasms
- Myositis
- Neoplasm Invasiveness
- Neoplasm, Residual
- Reproducibility of Results
- Sensitivity and Specificity
- Treatment Outcome
- Urinary Bladder Neoplasms