The use of MRI in urothelial carcinoma

Messina, Emanuele; Pisciotti, Martina Lucia; Pecoraro, Martina; Borrelli, Antonella; Giudice, Francesco Del; Panebianco, Valeria

doi:10.1097/mou.0000000000001011

Cited by 4 publications

(2 citation statements)

References 55 publications

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“…This will serve as a signal to alert surgeons, prompting them to meticulously evaluate different treatment approaches. Due to intrinsic characteristics, MRI can describe the risk of muscle invasion (T2 stage), while CT cannot do that [20]. Therefore, evaluating these results as a whole, MRI could be considered as innovative imaging tool for UTUC local staging, furnishing relevant information, being also a radiation-free, minimally invasive imaging modality.…”

Section: Discussionmentioning

confidence: 99%

MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study

Messina,

Proietti,

Laschena

et al. 2024

Eur Radiol Exp

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Background Magnetic resonance imaging (MRI) is recommended in patients with upper tract urothelial carcinoma (UTUC) only when computed tomography (CT) is contraindicated. However, CT does not allow distinguishing ureter wall layers, making impossible to assess muscle invasion, a factor contributing to differentiate high- from low-risk UTUCs, which require different therapeutic approaches. We investigated the feasibility of MRI assessment of UTUC muscle invasion. Methods From June 2022 to March 2023, we prospectively enrolled patients suspected of UTUC, i.e., with positive urinary tract ultrasound and/or ureteroscopy, or positive urinary cytology and/or hematuria but negative cystoscopy and bladder ultrasound at two Italian centers. They underwent CT followed by MRI (≤ 24 h apart), independently reported by two experienced radiologists, blinded from histopathology results. After imaging confirmation, they all underwent nephroureterectomy and histopathology analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. Results Thirty-nine lesions were detected in 30 patients on both CT and MRI. Muscle-invasive UTUC prevalence was 81% (21/26) among patients with MRI suspicion and 8% (1/13) among those without MRI suspicion (p < 0.001). Considering the assessment of muscle-layer invasion, the more experienced reader achieved 95% sensitivity (95% confidence interval 82−100), 71% specificity (47−88), 81% PPV (63−93), 92% NPV (70−100), 85% accuracy (67−96), and 0.84 AUC (0.70−0.98). Inter-reader agreement was substantial (κ = 0.73). Conclusions MRI showed a promising diagnostic performance for the assessment of UTUC risk of muscle invasion. Relevance statement Resulting feasible both in technical and clinical terms, MRI could be helpful for upper tract urothelial carcinomas pre-operative risk stratification, to allow a personalized patients’ management. These results play in favor of promoting preoperative MRI for UTUC, as already proven for bladder cancer. Key points • Muscle invasion is a crucial information for tailored treatments of upper tract urothelial carcinomas. • CT does not distinguish ureter wall layers, making muscle invasion risk assessment not feasible. • MRI was shown to reliably diagnose muscle-layer invasion by upper tract urothelial carcinomas (sensitivity 95%, specificity 71%). Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study

Messina,

Proietti,

Laschena

et al. 2024

Eur Radiol Exp

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“…Given that the potential treatment plan of UTUC is based on staging, while there are studies evaluating the role of imaging in differentiating between T1 and T2 disease, this has not yet translated to clinical practice. With further trials or through the development of new sequencing and the development of scoring systems similar to VIRADS, MRU sensitivity and specificity may approach that of CTU [36].…”

Section: Discussionmentioning

confidence: 99%

Imaging in Upper Tract Urothelial Carcinoma: A Review

Tsikitas,

Hopstone,

Raman

et al. 2023

Cancers

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Medical imaging is a critical tool in the detection, staging, and treatment planning of upper urinary tract urothelial carcinoma (UTUC). This article reviews the strengths and weaknesses of the different imaging techniques and modalities available clinically. This includes multidetector computed tomography (CT), multiparametric magnetic resonance imaging (MRI), ultrasound (US), and positron emission tomography (PET) for the detection, staging, and management of UTUC. In addition, we review the imaging techniques that are being developed and are on the horizon but have not yet made it to clinical practice. Firstly, we review the imaging findings of primary UTUC and the techniques across multiple modalities. We then discuss imaging findings of metastatic disease. Lastly, we describe the role of imaging in the surveillance after resection of primary UTUC based upon current guidelines.

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