Main description:

Carcinoma of the urinary bladder is a common (in the USA it is the fifth most common form of cancer in males and tenth most common form of cancer in females) malignan cy and one in which noninvasive staging by imaging plays such an important role. This book presents a complete approach to MR imaging of carcinoma of the urinary bladder from a detailed discussion of the value of MRI in the diagnosis of the urinary bladder to the history of the procedure. The technical discussion of the general principles of MRI including the optimal pulse sequences to be used and factors that influence the quality of images are included in this book. The safety factors are also presented along with contraindications. The application of a double surface coil with the field strength of O.5T provides the fine quality of the illustrations. The atlas of comparative anatomy by MRI on normal volunteers and post-mo'rtem specimens as well as MR images on patients with bladder tumors and post-surgery specimens is unique. The results of the clinical imaging stu dies in patients with carcinoma of the bladder, comparing the relative value of clinical staging, MR, CT and lymphography, are helpful in showing the advantages of MRI.

Contents:

I. Introduction.- 1.1 Magnetic spin tomography.- 1.2 Carcinoma of the urinary bladder.- 1.2.1 General aspects.- 1.2.2 Method of clinical staging.- 1.3 Diagnostic imaging of carcinoma of the urinary bladder.- 1.3.1 Intravenous urography.- 1.3.2 Ultrasound.- 1.3.3 Computed Tomography.- 1.3.4 Lymphography.- 1.3.5 Magnetic Resonance Imaging.- 1.4 Aims and design of this study.- II. General Principles Of MRI.- 2.1 Introduction.- 2.2 Basic physics of MRI.- 2.2.1 Nuclear spins, resonant frequency.- 2.2.2 Spin imaging: proton density, T1 and T2 relaxation times.- 2.3 Image contrast.- 2.3.1 'Inherent' tissue contrast, image contrast.- 2.3.2 Adjustable factors, pulse sequences.- 2.3.2.1 Spin-echo pulse sequence.- 2.3.2.2 Inversion recovery pulse sequence.- 2.3.2.3 Pulse sequence optimization.- 2.4 Strength of the magnetic field.- 2.5 Artifacts.- 2.5.1 Aliasing (wraparound) artifact.- 2.5.2 Fat-shift artifact.- 2.5.3 Artifacts caused by patients' movement.- 2.5.4 Metal artifacts.- 2.6 Advantages of MRI over other imaging techniques.- 2.7 Disadvantages of MRI compared with other imaging techniques.- 2.8 Safety of MRI.- 2.8.1 Short term effects.- 2.8.1.1 Static magnetic field.- 8.1.2 Effects of electrical currents induced by the main magnetic field varying in time.- 2.8.1.3 Warming/heating effects of RF signals.- 2.8.2 Long-term effects.- 2.9 Contraindications for MRI investigation.- III. Technical Aspects of Mri Specificially Relevant to Patients with Urinary Bladder Carcinoma.- 3.1 Introduction, optimal conditions for examination.- 3.2 Patient-related factors.- 3.2.1 Voluntary motion artifacts.- 3.2.2 Involuntary motion artifacts.- 3.2.3 Bladder distension.- 3.3 Pulse sequence optimization.- 3.3.1 Literature review.- 3.3.2 Evaluation of sequences most frequently used in the literature.- 3.3.2.1 T1-weighted sequences.- 3.3.2.2 T2-weighted sequences.- 3.3.2.3 Proton-weighted sequences.- 3.3.3 Determination of the optimal pulse sequence (1.5 T).- 3.3.3.1 T1 and T2 calculations to optimize the pulse sequence.- 3.3.3.2 Pulse sequence optimization by means of 'contrast matrices'.- 3.3.3.3 Pulse sequence optimization by means of 'synthetic imaging'.- 3.3.4 Interim conclusion.- 3.4 Body-coil MRI versus (double) surface-coil MRI.- 3.4.1 Results at a field strength of 0.5 T.- 3.4.1.1 Patients and methods.- 3.4.1.2 Results.- 3.4.1.3 Discussion.- 3.4.2 Results at a field strength of 1.5 T.- 3.4.2.1 Patients and methods.- 3.4.2.2 Results.- 3.4.2.3 Discussion.- 3.4.3 Interim conclusion.- 3.5 Comparison of staging results at 0.5 T and 1.5 T.- 3.5.1 Introduction.- 3.5.2 Patients, methods, and results.- 3.5.3 Discussion.- 3.6 Conclusion and protocol to be followed.- IV. Normal Mr Images: Correlation With Known Anatomic Proportions.- 4.1 Normal MR images of the pelvis.- 4.1.1 The male pelvis.- 4.1.2 The female pelvis.- 4.2 Correlation of MR images with anatomic sections.- 4.3 Correlations of MR images with sections of resected specimens.- V. Staging of Carcinoma of the Urinary Bladder on the Basis of MRI Results.- 5.1 Introduction.- 5.1.1 Survey of groups of patient.- 5.2 Evaluation of MRI, CT, and the clinical staging method compared with postoperative histopathologic staging based on cystectomy and autopsy specimens.- 5.2.1 Patients and methods.- 5.2.2 Results.- 5.2.2.1 Patients.- 5.2.2.2 MR images of resected specimens.- 5.2.3 Discussion.- 5.2.4 Interim conclusion.- 5.3. Evaluation of staging with MRI and CT by using a combination of clinical staging and follow-up as a reference.- 5.3.1 Patients and methods.- 5.3.2 Results.- 5.3.3 Discussion.- 5.3.4 Interim conclusion.- 5.4 Evaluation of staging with MRI by using a combination of clinical staging and follow-up as a reference.- 5.4.1 Patients, methods, and results.- 5.4.2 Discussion 101 5.4.3. Interim conclusion.- VI. Discussion, Conclusions and Future Perspectives.- 6.1 Discussion and conclusions.- 6.2 Future prospects.- 6.2.1 Surface coils.- 6.2.2 Contrast agents.- 6.2.3 Fast sequences.- VII. Summary.- References.