J Korean Soc Radiol.  2017 May;76(5):346-353. 10.3348/jksr.2017.76.5.346.

Application of Three-Dimensional Volumetric Ultrasonography in Patients with Bladder Cancer and Its Mimickers: A Pictorial Essay

• Ko S
• Hong SS
• Hwang J
• Kim HJ

• KMID: 2377038
• DOI: http://doi.org/10.3348/jksr.2017.76.5.346

Abstract

Various diseases of the urinary bladder can be demonstrated as being polypoid, a nodular bladder mass or as focal bladder wall thickening. This includes malignant or benign neoplasms, urinary stones, or other inflammatory bladder conditions. In daily practice many of these bladder diseases are easily confused with bladder cancer. On the other hand, ultrasonography (US) is safe and can be easily applied as a screening modality or an initial evaluating tool for urinary bladder disease. Furthermore, additional three-dimensional (3D) volumetric techniques can support more delicate delineation of these lesions. This study presents a 3D volumetric US for bladder lesions, and demonstrates various pathological conditions of the urinary bladder ranging from bladder cancer to other benign lesions.

MeSH Terms

Hand
Humans
Imaging, Three-Dimensional
Mass Screening
Ultrasonography*
Urinary Bladder Diseases
Urinary Bladder Neoplasms*
Urinary Bladder*
Urinary Calculi

Figure

• 

  Fig. 1 Superficial polypoid bladder tumor. A. 2D US reveals a tiny echogenic elevated bladder lesion (arrow) with indistinct margin. B, C. 3D US demonstrates the bladder nodule (arrow) with a clearer demarcation. D. Enhanced CT scan shows a well-enhanced polypoid bladder nodule (arrow) at the bladder base. CT = computed tomography, US = ultrasonography, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 2 Multiple superficial polypoid bladder tumors. A. 2D US of a collapsed bladder showing unclear polypoid bladder nodules. B. 2D US after bladder filling, three polypoid bladder nodules (arrows) are noted. C, D. 3D US clarified three bladder masses (arrows) at a similar site. An additional bladder nodule (arrowheads) is newly identified, which was not detected on the 2D US. The new bladder nodule was confirmed by conventional cystoscopy. US = ultrasonography, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 3 Bladder mass with indwelling urinary catheter. A. 2D US reveals an echogenic bladder mass (arrows) in a matching site, but contour of the bladder tumor is ambiguous, owing to the urinary catheter (C). B. 3D US provides clearer information about the margin and size of the bladder tumor (arrows) and clarifies the relationship between the tumor and the catheter (C). C. Enhanced CT scan shows a well enhancing bladder mass (arrows) along the left lateral wall of the urinary bladder, which is adjacent to the urinary catheter (C). CT = computed tomography, US = ultrasonography, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 4 Infiltrative bladder cancer in UVJ with hydroureter. A. At the sagittal plane of a 2D US, a round hypoechoic bladder mass (M) is identified at the left ureterovesical junction with an obstructive left hydroureterer (*). The outer contour of the urinary bladder (arrowheads) looks smooth, which suggests it has not yet progressed to a stage T2 bladder tumor. B. 3D US revealed that the outer wall (arrowheads) of the urinary bladder was irregular just beside the bladder mass (arrowheads) with an obstructive left hydroureter (*). These findings are suggestive of perivesical invasion (T3). The lesion was confirmed by surgery and pathologically reported as a perivesical invasion. US = ultrasonography, UVJ = ureterovesical junction, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 5 Direct invasion of the urinary bladder by advanced cervical cancer. A. 2D US shows a large ill-defined uterine cervical mass (M) extending to the bladder (BL) wall (arrowheads). B. 3D US demonstrates the margin of bladder mass more clearly than a conventional 2D US technique (arrowheads). US = ultrasonography, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 6 Metastatic bladder adenocarcinoma from advanced gastric cancer. 2D US and 3D US show diffuse infiltrative masses (arrowheads), confirmed to be have metastasized from gastric cancer to the lateral wall of the urinary bladder. US = ultrasonography, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 7 Focal cystitis. A. 2D US reveals multiple elevated nodular bladder lesions (arrows) with an indistinct margin. B. 3D US more clearly demonstrates bladder mucosal nodularity (arrows) than 2D US. US = ultrasonography, 2D = two-dimensional, 3D = three-dimensional

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  Fig. 8 A left UVJ stone. A. 2D US shows a small echogenic urinary stone (arrowhead) at the left ureterovesical junction with swelling of the surrounding soft tissue (arrows). B. 3D US demarcates the urinary stone (arrowhead) and swelling of left UVJ (arrows) more clearly. US = ultrasonography, UVJ = ureterovesical junction, 2D = two-dimensional, 3D = three-dimensional

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