The role of diffusion weighted magnetic resonance imaging and dynamic magnetic resonance imaging methods in the diagnosis of patients with bladder tumor.

Aim of this study was to investigate the efficacy of diffusion- weighted MRI in diagnosis and differentiation of bladder masses either as malignant or benign, superficial or invasive, transitional or squamous in patients presenting with hematuria who otherwise had normal ultrasonography.Between June 2008 and May 2009, 45 patients presented to our outpatient clinic with hematuria in whom cystoscopic assessment was planned and 30 volunteer with non-specific complaints other than hematuria were included into the study. DWMRI at b100, b600, b1000 gradient echo values were obtained from patients by DWMRI. Apparent Diffusion Coefficient (ADC) values were measured at the lesions or normal tissue in bladder of both patients and control subjects. Cystoscopically detected lesions were resected and benign or malignant differentiation was made by histopathologic examination. The ADC values on mass in all patients with benign or malignant patology and in control bladders were compared. Furthermore, ADC values of superficial-invasive and transitional-squamous bladder tumors were compared.ADC values, b100, b600, b1000, of malign lesions were measured as 1,41x103 ; 1,12x10-3; 0,88x10-3, respectively. These values were significantly lower than the values measured in normal healthy controls (3, 65x10-3; 2.59x10-3; 2.00x10-3 mm2/sec, respectively) ( p<0.05). Although ADC measurements of benign lesions detected in 10 patients (b100, b600, b1000) (1.82x10-3; 1.23x10-3, 0.92x10-3) were higher than the measurements obtained from malign lesions, no statistically significant diffeence was present (p>0.05). The comparison of ADC values between transitional and squamous cell cancer types revealed lower ADC levels for squamous type. Similarly, ADC levels measured at invasive tumors showed significantly lower ADC levels when compared to superficial malignancies (p<0.05).In conclusion, DWMRI seems to be a fast, effective, and an alternative method for diagnosis of bladder masses, for detection of the depth and type of the bladder tumor. However, there?s further need for large and controlled series for use of this technique in routine clinical practice of this method as adjunct to MRI protocol.Key Words: DWMRI, ADC, Bladder tumor, Hematuria