Skip to main content
Log in

Bladder tumour staging: comparison of diffusion- and T2-weighted MR imaging

  • Urogenital
  • Published:
European Radiology Aims and scope Submit manuscript


The aim of this work was to evaluate the clinical feasibility of diffusion-weighted (DW) MRI in detection and staging of urinary bladder tumour and to compare DW MRI with the T2-weighted technique. One hundred and six patients with bladder tumour were prospectively included in our study. All patients were evaluated with MR imaging. We started with axial T2-weighted high resolution MR of the urinary bladder, then DW MRI. Two radiologists independently interpreted the MR images, and discrepancies were resolved by consensus. The accuracy of DW MRI in staging of bladder tumour was evaluated using the final histopathological findings. In DW imaging (DWI) staging accuracy was 63.6% and 69.6% in differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours, respectively. On a stage by a stage basis, DWI accuracy was 63.6% (21/33), 75.7% (25/33), 93.7% (30/32) and 87.5% (7/8) for stages T1, T2, T3 and T4, respectively. In the T2-weighted technique, the overall staging accuracy was only 39.6% and accuracy for differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours was 6.1% and 15.1%, respectively. DW is superior to T2-weighted MRI in staging of organ-confined tumours (T2) and both techniques are comparable in the evaluation of higher-stage tumours.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Ghoneim MA, Abdel-Latif M, el-Mekresh M et al (2008) Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later. J Urol 180:121–127

    Article  PubMed  Google Scholar 

  2. Messing EM, Catalona W (1998) Urothelial Tumours of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (eds) Campbell’s urology. Saunders, Philadelphia, pp 2327–2408

    Google Scholar 

  3. Amendola MA, Glazer GM, Grossman HB, Aisen AM, Francis I (1986) Staging of bladder carcinoma: MRI-CT surgical correlation. AJR 146:1179–1183

    PubMed  CAS  Google Scholar 

  4. Tanimoto A, Yusa Y, Imai Y, Izutsu M, Hiramatsu K, Tachibana M et al (1992) Bladder tumour staging: comparison of conventional and gadolinium-enhanced dynamic MR imaging and CT. Radiology 185:741–747

    PubMed  CAS  Google Scholar 

  5. Caterino M, Giunta S, Finocchi V, Giglio L, Mainiero G, Carpanese L et al (2001) Primary cancer of the urinary bladder: CT evaluation of the T parameter with different techniques. Abdom Imaging 26:433–438

    Article  PubMed  CAS  Google Scholar 

  6. Husband JES, Olliff JFC, Williams MP, Heron CW, Cherryman GR (1989) Bladder cancer: staging with CT and MR imaging. Radiology 173:435–440

    PubMed  CAS  Google Scholar 

  7. Akmangit I, Lakadamyali H, Oto A, Özen H, Akhan O, Besim A (2003) Staging of urinary bladder tumours with CT and MRI. Turk J Diagn Intervent Radiol 9:63–69

    Google Scholar 

  8. Kundra V, Siverman PM (2003) Imaging in oncology from the university of Texas M.D. Anderson cancer center. AJR 180:1045–1054

    Google Scholar 

  9. Tillou X, Grardel E, Fourmarier M, Bernasconi T, Demailly M, Hakami F, Saint F, Petit J (2008) Can MRI be used to distinguish between superficial and invasive transitional cell bladder cancer? Prog Urol 18(7):440–444

    Article  PubMed  CAS  Google Scholar 

  10. Barentsz JO, Jager GJ, van Vierzen PB, Witjes JA, Strijk SP, Peters H, Karssemeijer N, Ruijs SH (1996) Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging. Radiol 201:185–193

    CAS  Google Scholar 

  11. Barentsz JO, Jager GJ, Witjes JA, Ruijs JHJ (1996) Primary staging of urinary bladder carcinoma: the role of MR imaging and a comparison with CT. Eur Radiol 6:134–139

    Article  Google Scholar 

  12. Cova M, Squillaci E, Stacul F, Manenti G, Gava S, Simonetti G et al (2004) Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol 77:851–857

    Article  PubMed  CAS  Google Scholar 

  13. Sato C, Naganawa S, Nakamura T, Kumada H, Miura S, Takizawa O et al (2005) Differentiation of non-cancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate. J Magn Reson Imaging 21:258–262

    Article  PubMed  Google Scholar 

  14. Yoshida S, Masuda H, Ishii C, Saito K, Kawakami S, Kihara K (2008) Initial experience of functional imaging of upper urinary tract neoplasm by diffusion-weighted magnetic resonance imaging. Int J Urol 15:140–143

    Article  PubMed  Google Scholar 

  15. Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Katsuoka Y (2007) Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results. Eur Radiol 17:201–204

    Article  PubMed  Google Scholar 

  16. El-Assmy A, Abou-El-Ghar ME, Refaie HF, El-Diasty T (2008) Diffusion-weighted MR imaging in diagnosis of superficial and invasive urinary bladder carcinoma: a preliminary prospective study. Scientific World J Urol 8:364–370

    Google Scholar 

  17. Sobin LH, Wittekind C (eds) (1997) International Union Against Cancer (UICC) TNM classification of malignant tumours, 5th edn. Wiley-Liss, New York

  18. Hricak H, White S (1997) Radiological evaluation of the urinary bladder and prostate. In: Grainger RG, Allison D (eds) Grainger and Allison’s diagnostic radiology: a textbook of medical imaging, vol 2. Churchill Livingstone, New York, pp 1427–1438

    Google Scholar 

  19. Nikken JJ, Krestin GP (2007) MRI of the kidney—state of the art. Eur Radiol 17:2780–2793

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ahmed El-Assmy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Assmy, A., Abou-El-Ghar, M.E., Mosbah, A. et al. Bladder tumour staging: comparison of diffusion- and T2-weighted MR imaging. Eur Radiol 19, 1575–1581 (2009).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: