Study On Relation Between Pathology Characteristic And Three-dimentional Contrast-enhanced Ultrasound In Bladder Tumor

Objective1. The purpose of this study was to evaluate the effectiveness of three-dimensionalcontrast-enhanced ultrasound (3D CE US) in differentiating diagnosisi of bladdertumor staging.2. To investigate the clinical efficacy of contrast-enhanced ultrasound quantitativeanalysis in the differential diagnosis of high and low grade urothelial carcinoma.Materials and Methods1. Evaluate the effectiveness of three-dimensional contrast-enhanced ultrasound(3D CE US) in differentiating diagnosisi of bladder tumor staging.(1)A total of60lesions in60consecutive patients with bladder tumors receivedthree dimensional ultrsonograhpy (3D US), low acoustic power contrastenhanced ultrasonography (CE US) and low acoustic power three-dimensionalcontrast-enhanced ultrasound(3D CE US) examination. The IU22ultrasoundscanner and a volume transducer were used and the ultrasound contrast agentwas SonoVue. The contrast-specific sonographic imaging modes were PI(pulseinversion) and PM(power modulation). The3D US, CE US, and3D CE USimages were independently reviewed by two readers who were not in the imagesacquisiton. Images were analyzed off-site. A level of confidence in the diagnosisof tumor invasion of the muscle layer was assigned on a5-degree scale. Receiveroperating characteristic analysis was used to asses overall confidence in thediagnosis of muscle invasion by tumor. Kappa values were used to assessinter-readers agreement. Histologic diagnosis was obtained for all patients.(2)We retrospectively analyzed sixty bladder tumors from fifty-four patients whichwere examined by three-dimensional ultrasound (3D-US), two-dimensional contrast-enhanced ultrasound (2D-CEUS)and3D-CEUS. The ultrasonographicfindings were compared with the pathologic stages.2. Evaluate the effectiveness of contrast-enhanced ultrasound (CE US) indifferentiating diagnosisi of bladder tumor grading.We retrospectively analyzed96bladder tumors from96patients which wereexamined by gray-scale contrast-enhanced ultrasound. Pathological examinationdemonstrated that55were high grade and41were low grade. The dynamicimages were analyzed by time-intensity curve, and AT, TTP, PI, and WT werecalculated. The enhancement patters of different bladder tumors were analyzed.When using the enhancement pattern as a diagnosis indicator to differentiatebladder tumors, the sensitivity, specificity, accuracy, positive predictive valueand negative predictive value were calculation.Results1. Evaluate the effectiveness of three-dimensional contrast-enhanced ultrasound(3D CE US) in differentiating diagnosisi of bladder tumor staging.(1) Final pathologic staging revealed44noninvasive tumors and16invasive tumors.Three-dimensional contrast-enhanced ultrasound depicted all16muscle-invasivetumors. The diagnostic performance of three-dimensional contrast-enhancedultrasound was better than those of three dimensional ultrsonograhpy andcontrast enhanced ultrasonography. The Receiver Operating Characteristic curveswere0.976and0.967for three-dimensional contrast-enhanced ultrasound, thosefor three dimensional ultrsonograhpy were0.881and0.869, those for contrastenhanced ultrasonography were0.927and0.929. The Kappa values in the threedimensional ultrsonograhpy, contrast enhanced ultrasonography andthree-dimensional contrast-enhanced ultrasound for inter-reader agreements were0.717,0.794and0.914.(2) Final pathologic staging revealed40noninvasive tumors:29categoryTa,11category T1, and20invasive tumors:4category T2a,6category T2b,and10 category＞T2.Superficial (Ta) tumors were correctly staged in72.4%(21/29)by3D-CEUS. Lamina propria infiltrating (T1) were correctly staged in90.9%(10/11) and the accordance of correct staging in invasive tumors (＞T1)by3D-CEUS was100%(20/20). The overall accuracy was85%(51.0/60).2. Evaluate the effectiveness of contrast-enhanced ultrasound (CE US) indifferentiating diagnosisi of bladder tumor grading.Both the PI and WT of high grade was higher than that of low grade (p<0.05).While for the AT and TTP, there was no statistically different between twogroups (p>0.05). Of55high grade bladder tumor,47(85.5%) were identified asfast wash-in and slow wash-out. Of41low grade tumor,35(85.4%) wereidentified as fast wash-in and fast wash-out. When using the enhancementpattern as a diagnosis indicator to differentiate bladder tumors, the sensitivity,specificity, accuracy, positive predictive value and negative predictive value were85.5%,90.2%,87.5%,92.2%,82.2%for high grade tumor and85.4%,90.9%,88.5%,87.5%,89.3%for low grade tumor.Conclusion(1) Three-dimensional contrast-enhanced ultrasound imaging, with contrast-enhancedspatial visualization is clinical useful for differentiating invasive and noninvasiveneoplasms of urinary bladder objectively.3D-CEUS has high diagnostic value indiscrimination the depth of bladder tumor invasion, This new technique mightimprove staging of bladder tumor.(2) Different grade bladder tumors show different enhancement finding oncontrast-enhanced ultrasound. The enhancement pattern is the importantdiagnostic indictor.