Syed Zafar H. Jafri MD, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Werner MD, Presenter: Nothing to Disclose

Farnoosh Sokhandon MD, Abstract Co-Author: Nothing to Disclose

In this retrospective study of patients with bladder carcinoma, we compared radiographic results using computed tomography urography with split bolus technique with the surgical pathology obtained from either biopsy and fulguration, transurethral resection, or cystectomy.  The purpose of this study was to evaluate the ultization of CTU in staging of bladder carcinoma. 

We retrospectively reviewed CTUs performed at our institution from Jan 03-Mar 08.  42 patients were identified that had pathologically proven bladder carcinoma who had underwent biopsy and fulguration, transurethral resection, or radical cystectomy.  The patients ranged in age from 33 to 90 years (mean age 68.5).  32 were males and 10 were females.  Scans were obtained on a 16 slice Siemens CT scanner. A split bolus CTU protocol was used. 2D and 3D reformatted images are obtained. The CTUs were reviewed independently by two radiologists who were blinded to the pathologic report and staging. Surgical-path correlation was obtained from review of the pathologic reports. The results of the pathologic staging were graded according to the Jewett-Strong-Marshall classification: Stage O: confined to the mucosa, Stage A: infiltration of submucosa, Stage B1: infiltration of superficial muscle, Stage B2: infiltration of deep muscle, Stage C: perivesical infiltration, Stage D1: involvement of adjacent organs/pelvic lymph nodes, and Stage D2: distant metastases/nodes above the aortic bifurcation.  

Out of 42 patients, 34 underwent transurethral resection, 4 underwent cystectomies, and 4 underwent biopsy with fulguration. 31 patients had an intrinsic bladder mass, 5 patients had both an intrinsic mass and focal bladder wall thickening, and 6 patients had only focal or diffuse bladder wall thickening. The path staging was 3 CIS, 21 Stage 0, 14 Stage A, 1 Stage B1, 2 Stage B2, and 1 Stage C. 4 cases had also associated CIS. We correctly staged 23 cases and overstaged 19 cases. We understaged 0 cases.

CTU utilizing split bolus technique is not an accurate modality in local staging of bladder carcinoma. CTU is optimal in evaluating the upper urinary tracts and in evaluating perivesical extension and metastases.

We found that CTU is suboptimal in evaluating local staging of bladder carcinoma; however, it is optimal in evaluting the upper tracts, perivesical extension, and metastases.

Jafri, S, Werner, E, Sokhandon, F, CT Staging of Bladder Carcinoma Utilizing CT Urograms.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010899.html