الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Bladder cancer is the fourth most common cancer in males and the tenth most common cancer in females. Urinary bladder cancer occurs three to four times more frequently in men than in women and has a high recurrence rate, necessitating long-term surveillance after initial therapy.
Patients with bladder cancer survive longer than those with most other common cancers. For the radiological evaluation of the urinary bladder and prostate gland, magnetic resonance imaging (MRI) is a valuable imaging modality due to high tissue contrast, multiplanar imaging capabilities, and the possibility of tissue characterization.
The usefulness of diffusion-weighted (DW) MR imaging for depicting malignant tumors, and an apparent diffusion coefficient (ADC) for characterizing tumor grades have been suggested recently. ADCs representing the degree of water molecular diffusion and the degree of restriction to water diffusion in biological tissues are inversely correlated to the tissue cellularity and the integrity of the cell membranes. Several authors had already reported decreased ADC among various malignant lesions due to dense cellularity and large cellular size.
The aim of current study was to assess the ability of diffusion weighted magnetic resonance imaging in urinary bladder cancer grading in comparison to histopathological grading as a gold standard reference data.
The current study included 20 patients with urinary bladder carcinoma included from urology department and Radio-diagnosis departments of Alexandria University hospital.
After obtaining an informed consent, all the subjects were subjected to full history taking and clinical examination including general examination and local examination. Laboratory investigation were done for all the cases. Radiological Investigations were conducted to all the cases including MRI scanning with calculation of apparent diffusion coefficient (ADC) maps.
Transurethral cystoscopy and biopsy was conducted in all the cases to detect the grades of the tumor.
The results of the study showed that:
• Study included 20 patients with urinary bladder cancer, 70% of them were males (14) and 30% were females (6).
• The age of the patients ranged from 20-80 years where the highest incidence was in the 6th decade (40%). The mean age (±SD) was (63.95 ± 13.04) years.
• Hematuria was the main common complaint in all the patients as 20 patients had hematuria (100%), ten patients had hematuria and dysuria (50%), nine patients presented Haematuria, Dysuria and Frequency (45%) and one patient had Haematuria, Dysuria and Urgency (5%).
• Fourteen out of twenty patients had no family history of bladder cancer (70%) while Six out of twenty patients had positive family history of bladder cancer (30%)
• Fourteen patients out of twenty had solitary lesions (70%) while six patients out of twenty had multiple lesions (30%) with total number of lesions examined 33 lesions.
• Considering distribution of the lesions according to the site of involvement; The most common site of lesions involved the lateral wall in 20 cases with involvement of only the lateral wall in 12 cases (36.4%) and lateral wall with extension to trigone or dome was found in four cases each (12.1%). The Bladder dome was involved in 9 cases with involvement of only the bladder dome in five cases (15.5%) and bladder dome with extension to lateral wall in four cases (12.1%). The trigone was involved in 9 cases with involvement of only the trigone in five cases (15.5%) and trigone with extension to lateral wall in four cases (12.1%).
• Considering distribution of the lesions according to their histological type. The most common histological type was urothelial carcinoma in 31 cases (94%), and one lesion of squamous cell carcinoma type and one of urothelial carcinoma with squamous differentiation.
• The ADC values are measured three times for each lesion and the mean of ADC value for the three measurements was recorded, the mean ADC value of low-grade lesions is 1.125 x 10-3 mm²/s while that mean ADC value of high-grade lesions 0.9837 x 10-3 mm²/s.
• 1 x 10-3 mm²/s is the cut-off point for ADC value, considering low ADC value as being less than 1 x 10-3 mm²/s which suggesting high histopathological grade while high ADC value as being more than 1 x 10-3 mm²/s which suggesting low histopathological grade.
• There was a statistically significant difference between the mean ADC value according to the grading prevailed by histopathological grading of the endoscopic biopsy.