Extraperitoneal paravesical spaces: CT delineation with US correlation

The extraperitoneal space around the urinary bladder is lamellate, just like the retroperitoneal space around the kidneys. The bladder, urachus, and obliterated umbilical arteries lie within the perivesical space, surrounded by umbilicovesical fascia, analogous to the perinephric space within the renal fascia. A much larger prevesical space, analogous to the anterior pararenal space, lies anterior and lateral to the umbilicovesical fascia. Posterior to the urinary bladder, the lower uterine segment or seminal vesicles lie within the perivesical space, rather than in a separate compartment, corresponding to the posterior pararenal space. The cul-de-sac, and the inferolateral extension of its peritoneal layers as the rectovaginal or rectovesical septum, separate the posterior perivesical space from the rectum. The sectional anatomy of these spaces, and particularly their computed tomographic and ultrasound appearances, were noted in normal anatomic sections, patients with extraperitoneal fluid collections, and a cadaver into which fluid was injected.     

Cerebral dysplastic vascular malformation: a developmental arrest

Carcinoma of the urinary bladder was staged both clinically and by CT in 32 patients before they underwent total cystectomy. Eleven of the patients had perivesical growth demonstrated at histopathological examination of the cystectomy specimen. This was diagnosed by CT in all 11 of these patients before cystectomy, but it was discovered by clinical staging in only four patients prior to cystectomy. Seven patients without histopathologically proved perivesical growth were considered to have perivesical spread as demonstrated by CT findings. Three of these patients had perivesical fibrosis that was misinterpreted as perivesical tumor growth, and in all seven patients the perivesical changes were adjacent to the area of present or previous changes in the bladder wall. CT is a valuable addition to clinical staging because it demonstrates perivesical tumor growth.     

Contrast-enhanced computed tomography to show perivesical extension in bladder carcinoma

Fifty-two patients (53 lesions) with muscle invasive carcinoma (T2/T3) of the urinary bladder were examined with computed tomography (CT) before planned total cystectomy. The object of CT was to demonstrate perivesical growth. All patients were examined before and after intravenous injection of contrast medium. The stages obtained from the precontrast and postcontrast scans were compared with the histopathologic stage from the cystectomy specimen. CT staged correctly 35 of the 53 lesions in the precontrast series and 46 of the 53 lesions in the postcontrast series. The improved accuracy from contrast enhancement resulted primarily from fewer cases being overstaged. The use of intravenous contrast medium improved accuracy of CT in evaluation of perivesical tumor growth.     

CT cystography in the evaluation of major bladder trauma.

Computed tomographic (CT) cystography has been advocated in lieu of conventional cystography in the initial work-up of patients with suspected urinary bladder trauma. CT cystography was applied to a classification scheme for bladder injury based on the degree of wall injury and anatomic location and demonstrated characteristic imaging features for each type of injury. In bladder contusion (type 1), findings are normal. In intraperitoneal rupture (type 2), CT cystography demonstrates intraperitoneal contrast material around bowel loops, between mesenteric folds, and in the paracolic gutters. Manifestations of interstitial injury (type 3) include intramural hemorrhage and submucosal extravasation of contrast material without transmural extension. In extraperitoneal rupture (type 4), the path of extravasated contrast material is variable: Extravasation is confined to the perivesical space in simple extraperitoneal ruptures, whereas in complex extraperitoneal ruptures, contrast material extends beyond the perivesical space and may dissect into a variety of fascial planes and spaces. Combined intra- and extraperitoneal rupture (type 5) usually demonstrates extravasation patterns that are typical for both types of injury. Familiarity with these CT cystographic features allows accurate classification of bladder injury and allows prompt, effective treatment with less radiation exposure than and without the added cost of conventional cystography.     

Scintigraphic assessment of perivesical urinary extravasation following renal transplantation

Radionuclide scintigraphy is a safe and accurate means of detecting postoperative urologic complications in renal transplant recipients. Early identification of urinary leakage coupled with aggressive intervention significantly reduces the associated morbidity and mortality. Perivesical extravasate may be difficult to distinguish from adjacent or nearby bladder activity on scintiscan. Clarification of actual bladder contour and determination of its exact location within the pelvis may resolve such uncertainties. We describe imaging techniques that define the anatomic extent of the bladder and demonstrate our scintigraphic assessment of perivesical extravasation.     

Features of irradiated urinary bladder tumors and their correlation with malignancy observed on computed tomography

CT features of 42 masses in the bladder wall were characterized and subjected to analysis to find indicators of malignancy. A CT technique with thin slices and intravenous contrast medium was used. Multiple regression and multivariate analysis showed good ability of contrast-enhanced CT to discriminate between benign and malignant masses in the bladder wall. Protrusion of a mass into the perivesical fat had some importance in discriminating between malignant tumors with and without perivesical growth although the detection of perivesical growth was less certain.     

MR imaging of urinary bladder neoplasms

The diagnostic potential of magnetic resonance (MR) imaging at 1.5 T for assessment and staging of urinary bladder tumors was investigated in 10 patients with malignant urinary bladder tumors. All patients underwent complete pathologic staging. The appearance of the urinary bladder tumors and the ability to stage them by means of MR imaging was evaluated morphologically and compared with results obtained with pathologic examination. Magnetic resonance imaging permitted tumor localization in all patients. In nine patients the tumor stage was accurately determined by MR imaging. The smallest tumor detected by MR imaging was 1.5 cm. Both transverse and sagittal imaging planes were found to be essential for accurate assessment of tumor extension. Signal intensity data obtained from both dual and multi spin echo sequences showed that tumor display and depth of infiltration was best seen with a repetition time (TR) of 2,000 ms and an echo time (TE) of 90 ms. Accurate evaluation of perivesical tumor infiltration required a sequence with a TR 800 ms and a TE 30 ms. Data presented here further support the role of MR in staging urinary bladder neoplasms.     

Accuracy in staging carcinoma of the bladder by magnetic resonance imaging

Thirty-four patients with a presumptive diagnosis of carcinoma of the bladder diagnosed at EUA and cystoscopy have been staged by MRI and the findings correlated with pathology in 15 patients and clinical follow-up, including repeat cystoscopy, in the remainder. MRI is accurate in identifying tumours confined to the bladder wall or extending beyond the wall to involve perivesical fat or adjacent organs. Whilst it is not possible to distinguish between T1, T2 or early T3a tumours they can be distinguished from advanced T3a lesions and this may affect management. MRI is superior to clinical staging, particularly in detecting lymphadenopathy and provides information for optimal radiotherapy planning. The problem of distinguishing between the effects of radiotherapy and suspected recurrent tumour is discussed.     

放射性膀胱疾病的临床观察

目的 探讨盆腔放疗时引起放射性膀胱疾病的临床特点、诊断、治疗措施并结合文献资料进行讨论，为规范放射性膀胱疾病的诊断提供依据。方法 采用临床病例分析方法。结果 宫颈癌放疗时放射性膀胱疾病发生率大约在0.8%-2.96%，平均2.14%。放射性膀胱疾病可分为急性放射性膀胱炎，慢性放射性膀胱炎和放射性膀胱瘘3型。临床上最多见的是慢性放射性膀胱炎，其临床主要表现为无痛性肉眼血尿，又分为轻、重两度。诊断时应有明确的射线接触史，并超过剂量阈值，出现典型的临床特征。结论 笔者全面分析了放射性膀胱疾病的临床特点、分型、诊断依据等可提供作为拟订诊断标准的参考。     

Vesical schistosomiasis: an uncommon cause of bladder wall thickening

Schistosomiasis is typically a tropical disease; however, given the large influx of immigrants to our country and the boom in tourism to exotic locations, schistosomiasis should be taken into account in the differential diagnosis of certain clinical entities. The flatworm Schistosoma haematobium can cause a large variety of lesions in the urinary tract. The most common sites of involvement are the bladder and the lower third of the ureters, where it can cause lesions ranging from lithiasis and ureteral stenosis to the formation of masses inside the bladder. Ultrasonography is the imaging technique of choice for evaluating these alterations in the bladder; in addition to being fast, noninvasive, and painless, it is very useful for monitoring the response to antihelmintic treatment. We believe that it is essential to know the alterations in the urinary tract caused by this trematode, as this infectious disease that can be cured with Praziquantel might be confused with tumor diseases, such as vesical masses.     

膀胱异位嗜铬细胞瘤的MSCT诊断

目的 讨论膀胱异位嗜铬细胞瘤MSCT表现.方法 对8例资料完整、经手术证实膀胱异位嗜铬细胞瘤的CT图像进行回顾性分析.结果 8例肿块均为单发,分别位于膀胱三角区(2例)、顶部(2例)、前壁(1例)、后壁(3例),2例位于粘膜下,6例位于膀胱肌层.病灶平扫呈均匀低密度,无囊变,1例可见环形钙化,增强扫描动脉期明显均匀强化,动脉期与平扫病灶CT值相差＞40HU,门脉期与动脉期CT值相差为15HU左右.结论 膀胱异位嗜铬细胞瘤在MSCT有其特征性表现,术前可以明确诊断.     

Small Cell Carcinoma of the Urinary Bladder: CT and MR Imaging Findings

Objective

Primary small cell carcinoma (SCC) is a rare aggressive malignancy of the urinary bladder, with identical histopathology to that of the lung. The treatment and prognosis of bladder SCC are somewhat different from those of more frequent transitional cell carcinoma. The purpose of this study was to analyze the CT and MR imaging findings of bladder SCC.

Materials and Methods

Six adult patients (five males and one female) with pathologically proven SCC of the urinary bladder who had undergone pelvic CT and/or MR imaging were included in this study. The radiologic findings were retrospectively evaluated in terms of tumor location, texture, calcification, depth of invasion, perivesical extension, lymph node involvement, and local or distant metastasis, by two radiologists, who established a consensus.

Results

CT and MR images depicted all tumors as large, ill-defined, relatively well enhancing, broad-based polypoid intramural masses with (n=3) or without (n=3) cystic portions. Their frequent location was posterior and trigonal (n=3). Calcification was found within one tumor, and lymphadenopathy in four. At T2-weighted MR images, the solid portion of the tumor was relatively hypointense. The stage at the time of diagnosis was C in three patients, and D1 in three. Follow-up imaging showed brain metastasis in one patient and liver metastasis in two.

Conclusion

On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass. It was stage C or higher, and lymph nodes and distant metastasis were frequent. T2-weighted MR images showed that the solid portion of the tumor was relatively hypointense. When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.     

Urinary bladder tumors studied by cystosonography. Part I: Detection

Findings of excretory urography, the principal screening test for bladder tumors, do not accurately depict these tumors. In an attempt to assess the value of sonography in detecting bladder lesions, we used suprapubic sonography to examine 120 patients who presented with various lower urinary tract symptoms. Commercially available equipment was used. Ultrasound detected 16 of the 17 cases of bladder tumor that were confirmed by cystoscopy. In 14 of these, satisfactory images were obtained. Nontechnical factors that affect detection include size and location of the tumor, bladder distention, obesity of the patient, and the operator's skill. Blood clot, benign prostatic hypertrophy, cystitis, and bladder trabeculae can mimic bladder tumors. Sonography may be helpful as an initial screening test for patients suspected of having bladder tumors; however, further experience is needed before conclusions can be made.     

Radiographic herald lesion of the urinary bladder: pictorial essay

At cystoscopy a focal mucosal abnormality may be indicative of a pathological process extrinsic to the urinary bladder and has been termed 'the herald lesion'. The aim of the present pictorial essay was to describe the radiographic counterpart to this cystoscopic finding. Radiographic herald lesions are shown in patients with extravesical inflammatory (Crohn's disease, colonic diverticulitis and pelvic inflammatory disease) and neoplastic (colon carcinoma) processes, and urinary tract complications of these conditions are described and illustrated.     

Bladder cancer imaging

Bladder cancer is a urinary system cancer, primarily afflicting older men. Smoking is the most significant risk factor. Symptoms include hematuria, urinary frequency or urinary urgency. Cystoscopy, radiologic techniques and biopsy results help health care providers diagnose, treat and monitor the disease. The prognosis of bladder cancer depends upon the invasiveness of the tumor and the extent of spread in the pelvic cavity. Treatment includes surgery, drug therapy, radiation therapy, chemotherapy or combinations thereof.     

CT evaluation of bladder and prostate neoplasms

The role of computed tomography in the preoperative staging of bladder and prostate tumors is discussed and illustrated. The accuracy of judging perivesical tumor extent, various techniques of CT examination, and the clinical significance of evaluating local bladder extension are discussed. The CT evaluation of local periprostatic extension of tumor is examined in relationship to the type of planned therapy. A dynamic technique for lymphadenopathy evaluation is detailed. The accuracy of demonstrating lymphadenopathy by CT and its therapeutic impact on the surgical treatment of bladder and prostate malignancies are discussed.     

腺性膀胱炎的临床与多层螺旋CT表现

目的 探讨腺性膀胱炎的临床和CT诊断特点. 方法 对12例经膀胱镜及病理确诊为腺性膀胱炎患者的临床、膀胱镜和CT表现进行回顾性分析,并复习相关文献. 结果 12例患者的临床表现为血尿8例,尿频、尿急和尿痛3例,排尿困难1例.病变好发于膀胱三角区、颈部和输尿管开口周围.其中3例CT检查未见异常,膀胱壁局限增厚7例,其范围约为1.6～5.5 cm,另1例表现为膀胱壁广泛增厚.平扫病灶为等密度,增强后仅轻度强化,CT值平均增加13.1 HU.结论 腺性膀胱炎的CT表现具有一定特征,但CT检查无异常者不能排除腺性膀胱炎的诊断.     

The diagnostic value of double-contrast-technique cystography in the evaluation of benign and malignant lesions of the urinary bladder (author's transl)]

Cystography by double-contrast-technique as a simple and quick method of evaluating benign and malignant lesions of the urinary bladder is being described. 301 examinations were reviewed and are being discussed in regard to diagnostic value, indication, complication and radiation exposure of this method. A few typical cases are being demonstrated to illustrate the value of this method in the spectrum of other diagnostic methods in the work-up of urinary bladder lesions.     

Diagnosis of ruptured bladder during a 99mTc-DTPA renal study: new indications for radionuclide cystography?

Radionuclide cystography, which is currently used to evaluate vesicoureteral reflux, has also been used to detect perirenal and perivesical urine leakage. We report a case of intraperitoneal bladder rupture and describe potential indications and advantages of cystography for detection and evaluation.     

Roentgenologic abnormalities of the urinary bladder secondary to Crohn's disease.

Urinary tract symptoms and signs may result from secondary involvement of the urinary bladder in patients with Crohn's disease. In a small but significant proportion of these individuals, urinary tract symptoms represent the initial or predominant mode of presentation. Such patients may be erroneously treated for primary infection of the lower urinary tract for prolonged periods before the intestinal origin of the disease process is discovered. Roentgenologic abnormalities of the urinary bladder may provide early and important clues to the correct DIAGNOSIS. The various abnormalities of the urinary bladder which may occur secondary to Crohn's disease are described and illustrated, and the roentgenologic differential diagnosis is discussed.