Computed tomography-virtual cystoscopy in the evaluation of a bladder mass: Could it replace standard conventional cystoscopy?

Abstract

Objective: To determine the role of computed tomography-virtual cystoscopy (CT-VC) in the detection and evaluation of bladder cancer, compared to standard conventional cystoscopy (CC).

Patients and methods: Twenty-five patients with a clinical presentation of a bladder mass(es) were selected from an outpatient urology clinic between May 2011 and August 2012. All patients were then assessed using multi-slice CT of the bladder, CT-VC and CC. The results were then compared amongst axial CT images, multiplanar reconstruction (MPR) images, CT-VC and CC, and compared with the pathological results.

Results: Forty lesions were found at CC in the 25 patients. MPR images had a greater sensitivity for detecting small masses of ⩽5 mm, and for identifying the location of the masses, especially basal (100%), than had axial images. The diagnostic results varied significantly (P = 0.031 and 0.039) between CC and axial images. The difference was slightly significant (P = 0.063) for MPR images and was not significant (P = 0.99) for virtual images.

Conclusions: Compared to CC, CT-VC was much less invasive, but it was not possible to take a biopsy and provide tissue for histopathology, and it could not depict flat lesions or mucosal colour changes. Therefore, CT-VC could be considered for bladder mapping before CC, in the follow-up of patients with superficial transitional cell carcinoma after transurethral resection of the tumour, in combination with urine cytology, and for patients in whom CC is difficult or contraindicated.

Keywords: 3D, three-dimensional; Bladder carcinoma; CC, conventional cystoscopy; CT; Conventional; Cystoscopy; MPR, multiplanar reconstruction; VC, virtual cystoscopy; Virtual.

Figure 1

An axial CT image of the urinary bladder showing a small bladder diverticulum at the right lateral bladder wall, with no masses detected.

Figure 2

An MPR image of the urinary bladder showing a suspected soft-tissue lesion within the diverticulum.

Figure 3

CT-VC of the bladder showing a diverticulum at the right lateral bladder wall, with a well-defined sessile mass within the diverticulum ≈9 mm long (that was confirmed by CC); the biopsy showed TCC Grade 2.