[Radiologic evaluation of parietal infiltration of bladder cancer (integrated imaging: US, TC, RM) and comparison with transurethral resection (TUR)].

In this work we checked the reliability of Ultrasounds (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in the staging of parietal infiltration of bladder carcinoma. We studied 49 patients with documented bladder carcinoma. All patients underwent CT examination, 43 patients to MR examination and 40 patients to US examination. Between the patients who underwent US examination, 35 out of them had a sovra-pubic Ecography, 27 patients a trans-rectal Ecography and in 30 patients a trans-uretral Ecography was performed. After radiologic examination, all patients underwent a deep fractionated trans-uretral resection of the neoplastic mass (TUR) for the tumor staging. The results of the computed images and US examinations were then compared with the TUR staging. Among the group of patients studied with US, the agreement between imaging and TUR staging was respectively of 51% for the sovra-pubic study, 44.5% for the trans-rectal study and 56.7% for the trans-uretral study. The agreement was of 55% with the CT studies and 45.7% with the MRI. The sovra-pubic US studies showed a good correlation in the evaluation of superficial lesions (Tis-T1 stadied on TUR), if compared to the CT and MRI studies; moreover US is certainly more suitable because of its lower price and discomfort for the patient. On the contrary patients with a documented stage > T1 need a CT and MRI study for the correct staging. MRI has shown to be more sensitive in selected cases with localization of tumor on the top of the bladder roof, on its floor or in the follow-up after TUR. CT scan showed a better reliability in the staging of superficial lesions (Tis-T1 stages). On the contrary MRI has shown to be more sensitive in distinguishing superficial lesions (T1-T2 stages) from deeper lesions with muscles infiltration (T3a stage) on the basis of the loss of the parietal hypointense line on the T2 weighted images. Tumors with a grade T3b or more are well studied in both CT scan and MRI, which allow to get more useful information than US about the lynphoglandular involvement.