Diffusion‐weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases

Abstract

0 3 1What ' s known on the subject? and What does the study add? Preoperative imaging of nodal status in patients undergoing radical cystectomy for bladder cancer lacks diagnostic accuracy. This is the fi rst study that has investigated nodal metastates in bladder cancer using DW-MRI. ADC derived from DW-MRI may be used to differentiate metastatic from non-metastatic lymph nodes. OBJECTIVE• To evaluate whether DW-MRI improves the detection of pelvic lymph nodes metastates in patients with bladder cancer undergoing radical cystectomy. PATIENTS AND METHODS• 36 patients with CT scan negative for nodal metastates underwent DW-MRI before surgery. Diagnostic accuracy of DW-MRI was compared with histopathological fi ndings.Study Type -Diagnostic (exploratory cohort) Level of Evidence 3a

Prognostic value of computed tomography before radical cystectomy in patients with invasive bladder cancer: imaging predicts survival

“…The accuracy was 72 and 86 % for bladder and lymph node staging. Similar studies have been published for different MRI techniques with limited validity due to insufficient study designs and small case numbers [10,11]. Although the method of comparing preoperative imaging with postoperative histology is generally useful for assessment of accuracy, it also exhibits several limitations: First, the comparison uses a surrogate parameter and not solid end points like survival, which is more meaningful for patients and clinicians.…”

The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

“…The NCCN guidelines recommend imaging with either contrast-enhanced CT scanning or MR Urography [11]; however, the sensitivity of these studies ranges from 60.0 to 76.4 % [17,18]. In order to improve staging-and by corollary assessment of response to chemotherapyalternative modalities are needed.…”

Contemporary role of advanced imaging for bladder cancer staging

“…Hence, there has been a significant movement in the past decade toward investigation and integration of advanced imaging including functional imaging with positron emission tomography (PET) agents, contrast agents, and anatomic imaging parameters measures of tissue density and composition, to optimize the evaluation of lymph nodes for better differentiation of metastatic infiltration [27][28][29][30][31][32]. These promising advances in imaging are critical in improving the field of bladder cancer treatment, as noninvasive preoperative staging can help in providing more accurate risk stratification and can direct care plans in the future.…”