Accuracy of contrast-enhanced ultrasound in the detection of bladder cancer

Abstract

Objective: To assess the accuracy contrast-enhanced ultrasound (CEUS) in bladder cancer detection using transurethral biopsy in conventional cystoscopy as the reference standard and to determine whether CEUS improves the bladder cancer detection rate of baseline ultrasound. Methods: 43 patients with suspected bladder cancer underwent conventional cystoscopy with transurethral biopsy of the suspicious lesions. 64 bladder cancers were confirmed in 33 out of 43 patients. Baseline ultrasound and CEUS were performed the day before surgery and the accuracy of both techniques for bladder cancer detection and number of detected tumours were analysed and compared with the final diagnosis. Results: CEUS was significantly more accurate than ultrasound in determining presence or absence of bladder cancer: 88.37% vs 72.09%. Seven of eight uncertain baseline ultrasound results were correctly diagnosed using CEUS. CEUS sensitivity was also better than that of baseline ultrasound per number of tumours: 65.62% vs 60.93%. CEUS sensitivity for bladder cancer detection was very high for tumours larger than 5 mm (94.7%) but very low for tumours ,5 mm (20%) and also had a very low negative predictive value (28.57%) in tumours ,5 mm. Conclusion: CEUS provided higher accuracy than baseline ultrasound for bladder cancer detection, being especially useful in non-conclusive baseline ultrasound studies.

How Much Dose Can Be Saved in Three-Phase CT Urography? A Combination of Normal-Dose Corticomedullary Phase With Low-Dose Unenhanced and Excretory Phases

“…In addition, the excretory phase is not the only phase in which urothelial cell carcinoma can be detected. Urothelial cell carcinoma becomes enhanced soon after contrast administration [6][7][8] and can be detected in the corticomedullary or nephrographic phase or if the urinary tract, including the bladder, is well distended with urine, which acts as a negative contrast medium.…”

“…When focus in recent years turned to urothelial cell carcinoma, the corticomedullary phase proved useful in detecting urothelial cell carcinoma in the upper urinary tract and bladder. Several reports describe urothelial cell carcinoma as strongly enhancing with contrast material [6][7][8] in the early phase after contrast administration. A prospective study with patients undergoing workup because of gross hematuria was performed with an unenhanced, corticomedullary, nephrographic, and excretory phase protocol.…”

CEUS in the study of bladder, method, administration and evaluation, a technical note

“…It has been demonstrated that CEUS improves the differential diagnosis of intraluminal masses, allowing the differentiation between tumors, which are vascularized and show enhancement, and clots, which do not enhance [4][5][6]. CEUS also resulted to be superior to grayscale ultrasound in assessing infiltration of the muscle wall-layer, but magnetic resonance imaging (MRI) and computed tomography (CT) remain the imaging modalities of choice for local staging of bladder tumors [7][8][9].…”

Nonionizing photoacoustic cystography in vivo

“…Contrast-enhanced MRI has been applied, but it is expensive and bulky [1]. Although ultrasound (US) imaging is real-time, portable, relatively cost effective, and safe, conventional US imaging is not sensitive, especially, for imaging bladder cancers [2].…”