You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2018MP08-03 ABSENCE OF INCHWORM SIGN ON DWI: A PREDICTIVE MARKER FOR PROGRESSION IN PT1 BLADDER CANCER shugo yajima, Soichiro Yoshida, Taro Takahara, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Kazunori Kihara, and Yasuhisa Fujii shugo yajimashugo yajima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Taro TakaharaTaro Takahara More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.308AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The utility of diffusion-weighted MRI (DWI) in the management of bladder cancer (BC) has been increasingly reported. The high signal intensity (SI) of BC with a low SI submucosal stalk shows an arch-like shape, which represents the papillary structure of the BC. This characteristic finding is called the “inchworm sign”, and is used as a criterion for T staging in NMIBC (T1 or less) (Takeuchi M, et al. Radiology 251:112-21, 2009). We evaluated the significance of the inchworm sign for recurrence and progression in the treatment course of T1 BC. METHODS Of the BC patients who were diagnosed with pT1 urothelial carcinoma between September 2007 and June 2016, 149 patients who underwent MRI examination including DWI (b-values of 0 and 1000 s/mm2) before TUR were retrospectively evaluated. A DWI image of the dominant BC was reviewed at a b value of 1000 s/mm2, and the presence of the inchworm sign was analyzed along with anatomic information from T2WI. The association of the presence of the inchworm sign or other clinical variables with progression at recurrence was evaluated. RESULTS Of the 149 included patients, we excluded 19 patients who had BC smaller than 10 mm on T2WI, 14 patients in whom muscle sampling was not performed, and 27 patients whose preoperative MRI could not be fully analyzed. The remaining 89 patients were eligible for the analysis. All tumors showed a high signal intensity on DWI. Of the 89 tumors, 60 (67%) were positive for the inchworm sign (IS), and 29 (33%) were negative for the inchworm sign (non-IS). During the median follow-up period of 27 months (range, 1–110 months), 24 IS patients (40%) and 14 non-IS patients (48%) experienced BC recurrence. At the time of recurrence, 1 (4%) and 7 (50%) BCs progressed to pT2 or greater in IS and non-IS patients, respectively. While the inchworm sign was not associated with recurrence, the progression rate was significantly higher in non-IS patients compared with IS patients (p = 0.0004) (Fig.). A negative inchworm sign and histological grade 3 were independent significant risk factors for progression (hazard ratio (HR) 9.7, p = 0.0018; HR 5.5, p=0.0191, respectively). CONCLUSIONS Absence of the inchworm sign in pT1 cancer predicts a high risk for progression at recurrence. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e96-e97 Advertisement Copyright & Permissions© 2018MetricsAuthor Information shugo yajima More articles by this author Soichiro Yoshida More articles by this author Taro Takahara More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...