Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging

This study was performed to assess the accuracy of MR imaging in revealing invasion of the urinary bladder by uterine cervical carcinoma. Vesical invasion was evaluated in 300 consecutive patients who underwent MR imaging for preoperative staging of uterine cervical carcinoma. MR imaging was obtained with a 0.5-T unit using spin-echo T1- and T2-weighted images. Contrast-enhanced T1-weighted images were also obtained in 199 patients. MR imaging findings were compared with surgical or cystoscopic findings. MR images were then reevaluated in all cases to detect any additional MR imaging findings suggestive of vesical invasion. Among the 300 patients, vesical invasion was present in 12 patients. For detecting vesical invasion, MR imaging had a sensitivity of 83%, a specificity of 100%, and an accuracy of 99% (10 true-positives, 288-negatives, no false-positives, and two false-negatives). MR imaging findings that suggested vesical invasion were nodularity and irregularity of the bladder wall (n = 5), masses protruding into the bladder lumen (n = 2), and high signal intensity of the anterior aspect of the posterior wall of the bladder (n = 7). In addition, we saw abnormal soft-tissue strands in the uterovesical space in the two false-negative cases. On reevaluation of the MR images in the true-negative cases, we did not see nodularity or irregularity of the bladder wall, masses protruding into the bladder lumen, high signal intensity of the anterior aspect of the posterior wall of the bladder, or soft-tissue strands in the uterovesical space. Familiarity with the MR imaging findings that we have described may prove helpful before surgery in detecting vesical invasion by cervical carcinoma.