Non-contrast magnetic resonance imaging for bladder cancer: fused high b value diffusion-weighted imaging and T2-weighted imaging helps evaluate depth of invasion

Eur Radiol. 2017 Sep;27(9):3752-3758. doi: 10.1007/s00330-017-4759-2. Epub 2017 Feb 6.


Objects: To investigate the utility of fused high b value diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) for evaluating depth of invasion in bladder cancer.

Methods: We included 62 patients with magnetic resonance imaging (MRI) and surgically confirmed urothelial carcinoma in the urinary bladder. An experienced genitourinary radiologist analysed the depth of invasion (T stage <2 or ≥2) using T2WI, DWI, T2WI plus DWI, and fused DWI and T2WI (fusion MRI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were investigated. Area under the curve (AUC) was analysed to identify T stage ≥2.

Results: The rate of patients with surgically confirmed T stage ≥2 was 41.9% (26/62). Sensitivity, specificity, PPV, NPV and accuracy were 50.0%, 55.6%, 44.8%, 60.6% and 53.2%, respectively, with T2WI; 57.7%, 77.8%, 65.2%, 71.8% and 69.4%, respectively, with DWI; 65.4%, 80.6%, 70.8%, 76.3% and 74.2%, respectively, with T2WI plus DWI and 80.8%, 77.8%, 72.4%, 84.9% and 79.0%, respectively, with fusion MRI. AUC was 0.528 with T2WI, 0.677 with DWI, 0.730 with T2WI plus DWI and 0.793 with fusion MRI for T stage ≥2.

Conclusion: Fused high b value DWI and T2WI may be a promising non-contrast MRI technique for assessing depth of invasion in bladder cancer.

Key points: • Accuracy of fusion MRI was 79.0% for T stage ≥2 in bladder cancer. • AUC of fusion MRI was 0.793 for T stage ≥2 in bladder cancer. • Diagnostic performance of fusion MRI was comparable with T2WI plus DWI. • As a non-contrast MRI technique, fusion MRI is useful for bladder cancer.

Keywords: Bladder cancer; Diffusion-weighted imaging; Fusion; MRI; Stage.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Carcinoma / diagnostic imaging*
  • Carcinoma / pathology
  • Diffusion Magnetic Resonance Imaging / methods
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Magnetic Resonance Imaging / standards
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Sensitivity and Specificity
  • Urethral Neoplasms / diagnostic imaging*
  • Urethral Neoplasms / pathology
  • Urinary Bladder Neoplasms / diagnostic imaging*
  • Urinary Bladder Neoplasms / pathology