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. 2012 Sep 24;15(4):247-51.
doi: 10.1016/j.jus.2012.09.002. Print 2012 Dec.

CEUS in the differentiation between low and high-grade bladder carcinoma

F M Drudi  1 , N Di Leo, F Malpassini, F Antonini, E Corongiu, F Iori
Affiliations

CEUS in the differentiation between low and high-grade bladder carcinoma

F M Drudi et al. J Ultrasound. .

Abstract
in English, Italian

Introduction: Bladder cancer ranks 4th overall in the number of newly diagnosed cancers and 10th in causes of cancer deaths. More than 90% of all cases of bladder cancer are transitional cell carcinoma (TCC). The goal of this study is to confirm the usefulness of low mechanical index contrast-enhanced ultrasonography (CEUS), also in association with time-intensity curves, in the differentiation between high- and low-grade bladder malignant lesions.

Materials and methods: From February 2006 to February 2012 we recruited 144 patients. All patients underwent grayscale ultrasonography (US), color-Doppler ultrasonography (CDUS) and contrast-enhanced ultrasonography (CEUS). Subsequently all patients underwent cystoscopy and TURB.

Results: HISTOLOGICAL DIAGNOSES WERE: 88 high-grade carcinomas (61.1%), and 56 low-grade carcinomas (38.9%). Sensitivity and specificity of CDUS were 87.5% (126/144) and 60%, respectively. Sensitivity and specificity of CEUS were 90.9% and 85.7%, respectively. Sensitivity and specificity of TIC were 91.6% (132/144) and 85.7%, respectively.

Discussion and conclusions: CEUS is a reliable noninvasive method for differentiating low- and high-grade bladder carcinomas since it provides typical enhancement patterns as well as specific contrast-sonographic perfusion curves.

Introduzione: Il carcinoma della vescica è al quarto posto complessivo per numero di tumori di nuova diagnosi e al decimo posto nelle cause di morte per cancro. Più del 90% di tutti i casi di cancro alla vescica sono dei carcinomi a cellule transizionali (CCT).Scopo di questo studio è stato quello di confermare l'efficacia dell'ecografia a basso indice meccanico con mezzo di contrasto (CEUS) anche con l'utilizzo di curve intensità-tempo (TIC) nella differenziazione tra lesioni vescicali di alto e basso grado.

Materiali e metodi: Da febbraio 2006 a luglio 2011 sono stati selezionati 144 pazienti. Tutti i pazienti sono stati sottoposti a ecografia in scala di grigi (US), ecocolor-Doppler (ECD) ed ecografia con mezzo di contrasto (CEUS). Successivamente tutti i pazienti sono poi stati sottoposti a cistoscopia e TURB.

Risultati: Le diagnosi istologiche sono state: 88 carcinomi di alto grado (61.1%), e 56 carcinomi di basso grado (38.9%). La sensibilità e specificità dell'ECD sono state dell' 87.5% e 60%, rispettivamente. La sensibilità e specificità della CEUS sono state del 90.9% e 85.7%, rispettivamente. La sensibilità e la specificità delle TIC sono state del 91.6% e 85.7%, rispettivamente.

Discussione e conclusioni: La CEUS è una tecnica affidabile e non invasiva per differenziare i carcinomi della vescica di basso e di alto grado, in quanto fornisce dei pattern tipici di enhancement, così come specifiche risultano essere le curve intensità-tempo.

Keywords: Bladder cancer; Color-Doppler ultrasonography, CDUS; Contrast-enhanced ultrasonography, CEUS; Time-intensity curves.

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Figures

Figure 1
Figure 1
High grade bladder tumor. (a) Grayscale US. (b) Color-Doppler shows strong flow signal inside the lesion (score 2). (c) CEUS shows mild enhancement of the lesion (score 1). (d) Time-intensity curve shows a shape C represented by a slow wash-in, with high SI and fast wash-out.
Figure 2
Figure 2
Low-grade bladder tumor. (a) Grayscale US. (b) Color-Doppler shows one pole of flow signal inside the lesion (score 1). (c) CEUS shows mild enhancement of the lesion (score 1). (d) Time-intensity curve shows a shape B revealing fast wash-in, but lower level of SI, with slow wash-out.
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