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Open AccessArticle

A Potential Application of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Combined with Photodynamic Diagnosis for the Detection of Bladder Carcinoma in Situ: Toward the Future ‘MRI-PDD Fusion TURBT’

1
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
2
Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
3
Department of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
4
Department of Pathology, Nara City Hospital, 1-50-1 Higashi kidera-cho, Nara, Nara 630-8305, Japan
*
Author to whom correspondence should be addressed.
Diagnostics 2019, 9(3), 112; https://doi.org/10.3390/diagnostics9030112
Received: 15 August 2019 / Revised: 30 August 2019 / Accepted: 2 September 2019 / Published: 4 September 2019
(This article belongs to the Special Issue Urogenital Cancers: Diagnostic, Predictive, and Prognostic Markers)
The detection of carcinoma in situ (CIS) is essential for the management of high-risk non-muscle invasive bladder cancers. Here, we focused on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with photodynamic diagnosis (PDD) for the detection of CIS. A total of 45 patients undergoing pre-surgical DCE-MRI and PDD-assisted endoscopic surgery accompanied by biopsies of the eight segmentations were analyzed. Immunohistochemical analysis of the biopsies revealed hypervascularity of CIS lesions, a cause of strong submucosal contrast-enhancement. It was found that 56 (16.2%) of 344 biopsies had pathologically proven CIS. In the DCE-MRI, the overall sensitivity and specificity for detecting CIS were 48.2% and 81.9%, respectively. We set out two different combinations of PDD and DCE-MRI for detecting CIS. Combination 1 was positive when either the PDD or DCE-MRI were test-positive. Combination 2 was positive only when both PDD and DCE-MRI were test-positive. The overall sensitivity of combinations 1 and 2 were 75.0% and 37.5%, respectively (McNemar test, vs PDD alone; p = 0.041 and p < 0.001, respectively). However, the specificity was 74.0% and 91.7%, respectively (vs PDD alone; both p < 0.001). Our future goal is to establish ‘MRI-PDD fusion transurethral resction of the bladder tumor (TURBT), which could be an effective therapeutic and diagnostic approach in the clinical management of high-risk disease. View Full-Text
Keywords: bladder cancer; carcinoma in situ; contrast-enhanced magnetic resonance imaging; 5-aminolevulinic acid; photodynamic diagnosis bladder cancer; carcinoma in situ; contrast-enhanced magnetic resonance imaging; 5-aminolevulinic acid; photodynamic diagnosis
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MDPI and ACS Style

Miyake, M.; Maesaka, F.; Marugami, N.; Miyamoto, T.; Nakai, Y.; Ohnishi, S.; Gotoh, D.; Owari, T.; Hori, S.; Morizawa, Y.; Itami, Y.; Inoue, T.; Anai, S.; Torimoto, K.; Fujii, T.; Shimada, K.; Tanaka, N.; Fujimoto, K. A Potential Application of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Combined with Photodynamic Diagnosis for the Detection of Bladder Carcinoma in Situ: Toward the Future ‘MRI-PDD Fusion TURBT’. Diagnostics 2019, 9, 112.

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