A NEW APPROACH IN THE DETECTION OF BLADDER LESION: CT CYSTOGRAPHY
(CTC) WITH VIRTUAL CYSTOSCOPY (VC).
De Berardinis E.#, Panebianco V.*, Giovannone R.#, Antonini G.#, Passariello R.*, Gentile V.#
and Busetto G.M. #.
* Sapienza Rome University Department of Radiology
# Sapienza Rome University Department of Urology
INTRODUCTION
Flexible cystoscopy represents the gold standard for diagnosis and local management of bladder
carcinoma. As the prevalence of transitional cell carcinoma is four-fold greater in men than in
women, the endoscopic procedure presents objective difficulties related to the length and bending of
male urethra. The most important problems are represented by intense discomfort for the patient
and bleeding; furthermore, the high cost, invasivity, and local complications such as infections and
mechanical lesions are well-known drawbacks. Additionally, flexible cystoscopy and PDD
cystoscopy does not provide information about extravesical extensions of the tumor. CT
cystography, combined with virtual cystoscopy, is mandatory for TNM staging of the tumor and
also is useful when conventional cystoscopy is inconclusive or cannot be performed. We present the
CT cystography findings with virtual endoscopy correlation and bladder carcinoma appearance.
METHODS AND MATERIALS
Eightyfour haematuric patients suspicious for bladder cancer and thirty patients who had undergone
transurethral resection of the bladder underwent CTC and Virtual Cystoscopy with multi detector
CT and Dual Energy technique after administration of i.v. contrast agent. Before CT examination, a
three-way 12-F Foley catheter was inserted into the bladder to achieve complete voiding. The
bladder was then distended by insufflating 350–500 cc of room air with 50 cc syringes, depending
on patient tolerance. Patient population was divided into three groups based on lesion size at PDDs
cystoscopy (Group 1: lesions with maximum diameter from 1 mm to 5 mm; Group 2: lesions
between 5.1 mm and 9 mm; Group 3: lesions larger than 9.1 mm). Results of the CT study were
compared with those of conventional cystoscopy and PDDs cystoscopy.
RESULTS
PDD cystoscopy depicted 264 bladder lesions in the 114 patients examined. Sensitivity and
specificity values of CTC and VC alone were constantly lower than those of the combined-approach
(group 1: 93.10% and 92.31%; group 2: 100% and 100%; group 3: 100% and 100%, respectively).
Regarding lesion size, it has been also demonstrate that multidetector-row CT performed with thinslice reconstructions (1 mm) allow a good sensitivity in the detection of lesion over 1 mm. ROC
analysis showed that the combined approach decreases the lower dimensional threshold for lesion
detection (1.4 mm). The study of bladder wall after administration of c.a. and Dual Energy
technique permit to distinguish superficial or infiltrative lesion in 69% of cases.
DISCUSSION
CTC and VC allow measuring in the range of 1-5 mm and to distinguish from superficial to
infiltrative lesions. The main disadvantage of CTC and VC is the low sensitivity to depict flat
lesions, as demonstrated performing cystoscopy with PDD. CTC can be used for the evaluation of
haematuric patients confining standard cystoscopy to a therapeutical role.
CONCLUSION
CTC and VC are promising diagnostic approach for bladder cancers detection.