MULTIMODALITY IMAGING OF BLADDER TUMOR VASCULARITY
publicité
MULTIMODALITY IMAGING OF BLADDER TUMOR VASCULARITY ROBERT L. BARD, M.D. DIRECTOR BIOFOUNDATION FOR ANGIOGENESIS RESEARCH & DEVELOPMENT NEW YORK CITY VITO CANTISANI, M.D. – ROME JELLE BARENTSZ, M.D. - NIJMEGEN OBJECTIVE • DEMONSTRATE THE VALUE OF DOPPLER SONOGRAPHY WITH DCE-MRI IN EVALUATION OF BLADDER CANCERS DISCLOSURE ROBERT L BARD-NOTHING TO DECLARE VITO CANTISANI-NOTHING TO DECLARE JELLE BARENTSZ-NOTHING TO DECLARE 2010 DIAGNOSTIC IMAGING BLADDER CANCER DETECTION: GOLD STANDARD = CYSTOSCOPY NON SPECIFIC: CT, PET, SPECT 2010 MULTIDISCIPLINARY NYU PROSTATE CANCER SYMPOSIUM 97% ACCURACY DOPPLER US/DCE-MRI INT SOC ENDOVASCULAR THERAPY 2009 NEOVASCULAR PATTERNS DCE-MRI SHOWS CAPILLARY NEOVASCULARITY DOPPLER IDENTIFIES VESSELS 0.5-1.5 MM WITH: ABNORMAL DISTRIBUTION LOSS OF NORMAL ARBORIZATION LOSS OF VASOMOTOR TONE & PRESENCE OF ARTERIOVENOUS SHUNTS PRODUCE LOW RESISTANCE FLOWS CONTRAST ENHANCED US (CEUS) SHOWS CAPILLARY NEOVASCULARITY MATERIALS AND METHODS • • • • PROSPECTIVE STUDY 36 MONTHS 3D / DOPPLER / CE-MRI 1139 PATIENTS AGE 37-94 BLADDER IMAGED DURING PROSTATE EXAMS WITH 29 LESIONS IDENTIFIED BY 3D 18 MHZ DOPPLER AND DCE-MRI • SCANS WITHIN 1 WEEK TIMEFRAME • HEMATURIA ABSENT IN ALL PATIENTS SURGICAL ZONES SONOGRAM ZONAL ANATOMY bladder Central Zone Peripheral Zone rectum MOST BLADDER CANCERS IMAGED AT TRUS LATERAL BLADDER MRI prostate pubis anus SESSILE TRANSITIONAL CELL CA URETERAL JET ARTIFACT TRANSVERSE T2 TRANSVERSE DCE NORMAL BLADDER NOTE LEFT PERIRECTAL NODE + SV INVASION 4 MM CALCULUS HEMATURIA AFTER PROSTATECTOMY SUBMUCOSAL FIBROMA 4 mm calculus SPECULAR REFLECTOR MULTIPLE MICROCALCULI SAME PATIENT LAST SLIDE NOTE SONIC SHADOW MULTIPLE CALCULI SAME PATIENT LAST SLIDE MULTIPLE CALCULI SAME PATIENT LAST SLIDE SINGLE CALCULUS COMPLEX CALCULUS 3-D IMAGE OF CALCULUS NORMAL R BLADDER 2008 2 YEAR FOLLOW UP ON NEXT SLIDE NOTE MASSIVE PROSTATE CANCER NEOVASCULARITY NEW VASCULAR NON – PROSTATIC MASS 2010 NOTE IMPROVED PROSTATE TUMOR NEOVASCULITY 8X10 MM PAPILLARY TCC 9X13 MM TCC 14 MM TCC 14x21 mm TCC SAME PATIENT PREVIOUS SLIDE 50 MM TCC 60 MM TCC SURGICAL VESSEL MAP SAME PATIENT LAST SLIDE INTRATUMOR VESSELS SAME PATIENT LAST SLIDE LEFT HYDRONEPHROSIS SYMPTOMS: L FLANK PAIN & FREQUENCY LOW VASCULAR MASS SAME PATIENT LAST SLIDE 3D OF VASCULAR PEDICLE SAME PATIENT LAST SLIDE PROLAPSED URETERAL TCC LEFT VASCULAR PEDICLE EXTENDS INTO BLADDER URETER PROSTATE CANCER GLEASON 5+4 LEFT PERIRECTAL AND PELVIC SIDE WALL ADENOPATHY NOTE ECCENTRIC BLADDER BASE INVASION PROSTATE CANCER WITH BILATERAL TCC SMALL RIGHT/LARGE LEFT BLADDER BASE TRANSITIONAL CELL CARCINOMAS HIGH GRADE BLADDER TCC LEFT LOW GRADE PROSTATE CANCER – YELLOW CIRCLE BLADDER RECTUM RIGHT SEMINAL VESICLE INVASION -YELLOW OVAL RESULTS 12/14 MALIGNANT TUMORS WERE VASCULAR SMALLEST LESION DETECTED = 8 MM 15 AVASCULAR LESIONS WERE BENIGN (STONES, POLYPS, HEMATOMAS) VASCULAR IMAGING MAY DEMONSTRATE PROSTATE CANCER EXTENSION INTO THE BLADDER BY DELINEATING A VASCULAR CONNECTION BETWEEN THE BLADDER MASS AND THE PROSTATE GLAND BASE ROBERT L. BARD, M.D., P.C. BIOFOUNDATION FOR ANGIOGENESIS RESEARCH & DEVELOPMENT 121 EAST 60TH ST. STE. 6A NEW YORK, NY 10022 TEL# 212-355-7017 FAX# 212-752-6192 www.cancerscan.com [email protected]