Diagnostic significance of peritumoral enhancement in distinguishing between muscle-invasive and non-muscle-invasive bladder cancer

Mitsuru Takeuchi; Atsushi Higaki; Yuichi Kojima; Kentaro Ono; Takuma Maruhisa; Takatoshi Yokoyama; Hiroyuki Watanabe; Akira Yamamoto; Tsutomu Tamada

doi:10.1007/s00261-024-04658-1

Diagnostic significance of peritumoral enhancement in distinguishing between muscle-invasive and non-muscle-invasive bladder cancer

Abdom Radiol (NY). 2024 Oct 30. doi: 10.1007/s00261-024-04658-1. Online ahead of print.

Authors

Mitsuru Takeuchi^{1

2}, Atsushi Higaki³, Yuichi Kojima³, Kentaro Ono³, Takuma Maruhisa³, Takatoshi Yokoyama³, Hiroyuki Watanabe³, Akira Yamamoto³, Tsutomu Tamada³

Affiliations

¹ Radiolonet Tokai, Nagoya, Japan. [email protected].
² Kawasaki Medical School, Kurashiki, Japan. [email protected].
³ Kawasaki Medical School, Kurashiki, Japan.

PMID: 39472381
DOI: 10.1007/s00261-024-04658-1

Abstract

Objective: The aim of this study was to assess the prevalence of peritumoral enhancement (PTE) in patients with muscle-invasive bladder cancer (MIBC) and non-MIBC (NMIBC) and to propose a modified diagnostic criterion for Vesical Imaging Reporting and Data System (VI-RADS) that incorporates PTE.

Materials and methods: This retrospective study included 95 patients with bladder cancer (age, 72 ± 11; 77 men; 36 MIBCs and 59 Non-MIBCs) who underwent multiparametric MRI in our referral center between 2011 and 2023. The images were interpreted by four radiologists. The readers classified the possibility of muscle layer invasion into categories 1-5, based on the VI-RADS categorical diagnostic criterion. PTE was defined as a linear contrast enhancement observed at the edge of tumor invasion which is convex outward from the normal bladder wall and contrasts more than the normal muscle layer and tumor. A modified VI-RADS that upgrades the final VI-RADS category to 4 if PTE is present when the original VI-RADS category is 3 or less was proposed. The frequency of PTE in the MIBC and NMIBC groups was compared using the Fisher's exact test. Sensitivity and specificity for the diagnosis of MIBC were compared with the original VI-RADS using McNemar test. Pathologic diagnosis was used as the reference standard.

Results: PTE was present in 70-81% (25/36-29/36) of MIBC and absent in 92-98% (54/59-58/59) of non-MIBC. For all readers, the PTE was significantly more frequent (p < 0.001) in the MIBC group than the NMIBC group. The sensitivities of modified VI-RADS (75.0-86.1%) were significantly higher than those of original VI-RADS (41.7-55.6%) (p = 0.002-0.008). The specificity of modified VI-RADS (91.5-98.3%) were not statistically different from original VI-RADS (98.3-100%).

Conclusions: In conclusion, PTE is a highly specific finding for MIBC. modified VI-RADS incorporating PTE increases sensitivity for MIBC.

Keywords: Dynamic contrast-enhanced imaging; Multiparametric magnetic resonance imaging; Urinary bladder neoplasms; VI-RADS; peritumoral enhancement.