You have accessJournal of UrologyImaging/Radiology II1 Apr 2014MP7-09 DIFFUSION-WEIGHTED MRI FOR ASSESSING THE RESPONSE OF MUSCLE-INVASIVE BLADDER CANCER TO CHEMORADIOTHERAPY Soichiro Yoshida, Fumitaka Koga, Hiroshi Tanaka, Shiro Satoh, Yasukazu Nakanishi, Toshiki Kijima, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Yasuhisa Fujii, and Kazunori Kihara Soichiro YoshidaSoichiro Yoshida More articles by this author , Fumitaka KogaFumitaka Koga More articles by this author , Hiroshi TanakaHiroshi Tanaka More articles by this author , Shiro SatohShiro Satoh More articles by this author , Yasukazu NakanishiYasukazu Nakanishi More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.332AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate assessment of the response to chemoradiotherapy (CRT) is an essential part of bladder-sparing therapeutic protocols against muscle-invasive bladder cancer (MIBC). However, conventional imaging studies are not useful to evaluate the therapeutic response because of the inability to distinguish residual cancer from changes secondary to the treatment. Diffusion-weighted MRI (DWI) is a functional imaging technique that derives image contrast from differences in the motion of water molecules in tissues. We prospectively investigated the ability of DWI to predict the therapeutic response to CRT for MIBC. METHODS From November 2007 to July 2012, 70 MIBC patients (T2/T3/T4a: n = 37/30/3) who underwent induction CRT comprised of radiotherapy (40 Gy) concomitant with 2 cycles of cisplatin (20 mg/day for 5 days) followed by partial (n = 41) or radical cystectomy (n = 29) were prospectively enrolled in this study. Four to 6 weeks after completion of CRT, the patients were examined using 1.5T MRI (Intera Achieva; Philips) with a 4-channel SENSE body coil including T2-weighted imaging (T2WI) and DWI. Bladder wall thickening in T2WI and high signal intensity with a b-value of 1000 mm2/s in DWI were assigned to positive findings. Two radiologists who were blinded to the clinical data independently interpreted the images. The results of each protocol were compared using the pathological results of the cystectomy specimen. RESULTS Overall, pathological examination of the cystectomy specimens revealed a pathologically complete response (pCR) in 47 patients (67%). Both reviewers predicted pCR in 41 patients (87%) using DWI, which was more accurate than that using T2WI. The sensitivity/specificity/accuracy of T2WI and DWI in detecting residual disease was 57/57/57% and 70/87/80% for reviewer 1, respectively, and 70/66/67% and 65/87/80% for reviewer 2, respectively. Despite comparable sensitivity, DWI was significantly superior in specificity and accuracy to T2WI (p = 0.003 and 0.002 for reviewer 1 and p = 0.002 and 0.023 for reviewer 2). 4 (57%) of 7 and 4 (50%) of 8 patients whose residual disease was not detected on DWI by reviewer 1 and reviewer 2, respectively, were cancers smaller than 5 mm. CONCLUSIONS DWI is superior compared to T2WI in assessing therapeutic response to CRT for MIBC. The high DWI specificity indicates that DWI is useful for accurately predicting pCR, and thus non-invasively allowing more optimal patient selection for bladder-sparing protocols. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e68-e69 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Soichiro Yoshida More articles by this author Fumitaka Koga More articles by this author Hiroshi Tanaka More articles by this author Shiro Satoh More articles by this author Yasukazu Nakanishi More articles by this author Toshiki Kijima More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Noboru Numao More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...