Role of mp-MRI in staging of bladder ca
Fig: Demonstrates how MRI is better the CECT to detect if there is muscle invasion by the tumor. Muscle layer is black (white arrow) and is intact in this case (VI-RADS 2)
Why Local Staging:
Key feature in deciding the optimal management of bladder ca is to know, if it is a non-muscle invasive tumor (NMIBC) or a muscle invasive tumor (MIBC).
Local Staging & 5 year Survival:
T Stage 5 Year survival
T1: Limited to urothelium 96 %
T2: Muscle invasion 70 %
T3: Extra vesicle invasion 39 %
T4: Adjacent organ and node 39 %
Treatment of Choice:
Non-invasive tumors: Trans urethral resection of bladder tumor (TURBT)
Invasive tumors: Radical Cystectomy / Chemotherapy / Radiation or
combination
Diagnostic Accuracy of MRI:
As per literature the diagnostic accuracy of MRI in local staging is as follow:
Sequence % accuracy
1. T2 W 72
2. Dynamic contrast 87
3. DWI 92
4. Multi-parametric MRI (mp-MRI) 95
How MRI Helps
1. It does local staging
2. Prognosticates
2. Plan TURBT for histopathological staging
3. Counsel the patient based on the MRI findings
Multi Parametric MRI: 3 key sequences
1. High Resolutions small FOV T2 W TSE (tra / cor / sag)
2. DWI b 800
3. Dynamic contrast 3D T1W FS
VI-RADS (Vesicle Imaging Reporting And Data System)
It is a structured reporting system to detect muscle invasive bladder ca
VI-RADS 4 (Stage T2) represents muscle invasion. This finding changes the management
Prepared By: Dr. Sharad Maheshwari
30.03.2023
Updated:
References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807353/
2. https://www.urologyhealth.org/urology-a-z/m/muscle-invasive-bladder-cancer
3. https://www.cancer.net/cancer-types/bladder-cancer/statistics
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446004/
5. https://ejrnm.springeropen.com/articles/10.1186/s43055-020-00343-7
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