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Journal ID : TMJ-11-03-2022-11187
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Title : The Differences Of Advanced MRI Techniques And Protocols In Diagnosis And Staging Of The Urinary Bladder Carcinoma In Comparison With Histopathological Findings

Abstract :

Bladder cancer is the second most common type of cancer of the urinary system in the world, after prostate cancer. Thus, we use a combination of the best imaging technology in the diagnosis and treatment of bladder cancer, because of its accuracy in local staging and grading. To determine the accuracy and effectivity of MRI in early detection and diagnosis of bladder carcinoma by using different protocols and to Compare the sensitivity of MRI in staging of urinary bladder carcinoma with histopathological findings. A prospective cross sectional study was conducted in an oncology teaching hospital /the complex of Baghdad medical city. This study involved 41 suspected patient (35male &6 female). The participants ranged from (31–83 years) throughout the period of from September 2021 to January 2022. Patients who were referred for examination and diagnosis due to pelvic pain and hematuria, or who had been suspected of having bladder cancer by ultrasound were included in the study and were evaluated by the MRI performed with an MRI scanner (1.5 Tesla, Siemens). The study included 41 patients with bladder cancer, mean age was 64.8 years ranging from (31-83 years), about 31.7% was in 61 – 70 years, and about 24.4 was in 71–80 years, 85.4% were males, and 97.6% were smokers.82.9% with chronic renal disease (UTI),56.1% with heterogeneous enhancement & 39% with homogenous enhancement ,4.9% non-enhanced. 38 patients with symptom of hematuria, the lesion location according to the its site in the bladder wall was 34.1% in the lateral wall,24.4% in the posterior wall. The stages of T-primary tumor in MRI common protocols was (Tis=12%, Tia=10%, T1=17%, T2=18%, T3=28%, T4=15%). The accuracy and sensitivity for early stages (Tis,Ta,T1.&T2) in conventional MRI protocols)T1WI,T2WI) was Inconclusive in the diagnosis of bladder carcinoma accuracy ranging (44% – 57%) & sensitivity ranging (50% – 75%), while in both advance MRI modalities) DCE &DWI) had specificity for diagnosing stage bladder CA with DWI offering slightly higher sensitivity (SN), negative predictive values (NPV), positive predictive value (PPV), and accuracy (SN: 100% vs. 100%, SP: 50% for DCE &100% for DWI, accuracy: 97.6% vs 100%, PPV: 97.5% vs. 100%, and NPV: 100% vs.100%). Both Diffusion weighted MRI and dynamic contrast enhanced MRI offer excellent agreement for T-staging of bladder cancer, Diffusion weighted MR imaging (DWI) and dynamic contrast enhanced MRI (DCE) at 1.5 tesla are a good modalities of imaging for the early detections and staging of the bladder carcinoma, with DWI is preferred without use of contrast media, which is why, it may be utilized in the patients who have contrast media allergy or renal impairment.

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