Ramkumar, J (2014) Evaluation with diffusion weighted magnetic resonance imaging in staging and grading of urinary bladder cancer. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Bladder cancer is a common genitourinary tract malignancy. Following prostatic adenocarcinoma, it represents the second most common tumour of urological malignancy in the world1. Urothelial tumours are cancers of the environment and advanced age. Bladder cancer is associated with old age and exposure to industrial toxins and smoking. It occurs most commonly in males than compared to female patients with ratio of 3:1 and is rare in the population less than 40 years of age. According to WHO 2004 classification, urothelial tumours are categorized to muscle non-invasive and muscle invasive, based on invasion of detrusor muscle. Eighty percent of urothelial cancers are non-muscle invasive in nature and present with various types of growth pattern. Muscle-invasive tumour is defined by high grade and cancer cells invading through the lamina propria into the deeper muscle layers. Histologically, urothelial carcinoma constitutes 90 percent of bladder cancers, five percent are squamous cell carcinoma and less than five percent are adenocarcinoma or other types of tumours. The management of bladder cancer varies according to muscle non-invasive and muscle invasive nature of the cancer. Muscle non-invasive tumours are managed with transurethral resection (TUR) and intravesical immunotherapy /chemotherapy. The treatment options for muscle invasive bladder cancer are radical cystectomy, radiation therapy, chemotherapy, or a combination. Thus it would be prudent to diagnose and differentiate between these two categories preoperatively by imaging techniques which helps in planning the treatment and in identifying the prognostic factors. AIM AND OBJECTIVES : To predict the pathological stage and grade of bladder cancer preoperatively by using Diffusion weighted Magnetic Resonance Imaging. To study the correlation of Diffusion Weighted MRI findings with clinical, radiological and pathological findings. PATIENTS AND METHODS : Inclusion Criteria : All new patients presented with total hematuria were evaluated initially with ultrasonography of abdomen and pelvis and diagnosed cases of Carcinoma bladder were included. Exclusion Criteria: 1. Patients with Previous TURBT, 2. Previously received intravesical therapy, systemic chemotherapy and external beam radiotherapy. METHOD OF STUDY : Informed consent obtained from all the patients after explaining details of the study. All details were recorded in a proforma as an inpatient procedure. Analysis was done with the collected details prospectively. All cases of carcinoma bladder was evaluated by clinical examination, renal function tests, urine cytology, imaging studies in the form of USG/CECT KUB. DW MRI of KUBU region was taken at the time of hospital admission. The TUR procedure was done within one week from the imaging procedure. CONCLUSION : DW MRI findings significantly correlate with histopathology in differentiating non muscle invasive bladder tumours from muscle invasive bladder tumours and also in local nodal staging. Grading of bladder tumour could be assessed with DW MRI as high grade tumours had significantly lower ADC values compared to low grade tumours. Hence in the preoperative evaluation of bladder cancers, DW MRI is a useful diagnostic imaging study both for grading and local staging of bladder cancers.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | diffusion weighted magnetic resonance imaging ; staging and grading ; urinary bladder cancer ; Evaluation. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 10 Aug 2017 02:26 |
| Last Modified: | 10 Aug 2017 08:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2558 |
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