mpMRT der Harnblase – Stellenwert und klinischer Einsatz

Zusammenfassung

Die initiale Diagnose und das Staging des Harnblasenkarzinoms birgt Herausforderungen. TUR-B und CT-Diagnostik sind bei der Aussage einer Muskelinvasion und der Invasion des perivesikalen Fetts limitiert. Die multiparametrische MRT (mpMRT) der Harnblase erlaubt eine zuverlässige Aussage über eine Muskelinvasion eines vorliegenden Harnblasentumors. Mittlerweile liegen zahlreiche retro- und prospektive Studien vor, die eine sehr hohe diagnostische Genauigkeit der mpMRT in dieser Fragestellung attestieren. Aktuelle Metaanalysen zeigen Sensitivitätswerte von bis zu 90% bei gleichzeitig hoher Spezifität von >85%. Das „Vesical Imaging-Reporting and Data System“ (VI-RADS) der mpMRT der Harnblase ist ein standardisiertes und klinisch einfach anzuwendendes Befundsystem. Die EAU-Leitlinien sehen die mpMRT und das VI-RADS-System zum lokalen Staging beim Harnblasenkarzinom vor. Auch ein kürzlich veröffentlichtes Consensus Statement auf Basis einer Delphi-Conference von 92 internationalen Experten empfiehlt den Einsatz der mpMRT in verschiedenen klinischen Situationen, u.a. vor und nach einer TUR-B, wenn eine Muskelinvasion möglich ist oder während der neoadjuvanten Chemotherapie.
Die mpMRT der Harnblase kann basierend auf einer guten Evidenzlage mittlerweile in verschiedenen klinischen Szenarien eine sinnvolle Ergänzung zur bereits etablierten Diagnostik beim Harnblasenkarzinom darstellen. Die Kosten und die limitierte Erfahrung stehen einem breiten Einsatz aktuell noch im Weg.

Abstract

The diagnosis and staging of bladder cancer is challenging. TUR-B and CT diagnostics bear limitations in detecting muscle invasion and perivesical fat invasion. Thus, second TUR-B is required to ensure more reliable pathological staging. The mpMRI of the urinary bladder is a new diagnostic tool in evaluation of tumor muscle invasion. Numerous retrospective and prospective studies indicate high diagnostic accuracy of the mpMRI in this setting. Current meta-analyses show sensitivities of up to 90% with a high specificity of >85%. The “Vesical Imaging-Reporting and Data System” (VI-RADS) is a standardized and clinically easy-to-use reporting system for mpMRI of the urinary bladder. The EAU guidelines recommend the mpMRI and the VI-RADS system for local staging of urinary bladder cancer. A recently published consensus statement based on a Delphi conference of 92 international experts favors the use of the mpMRI in various clinical situations. This includes imaging before and after TUR-B when muscle invasion is possible or during neoadjuvant chemotherapy.
Based on good evidence, the mpMRI of the bladder emerges as a useful imaging tool in the evaluation of urinary bladder cancer in various clinical scenarios. Availability, costs and limited experience currently stand in the way of widespread use.

Schlüsselwörter

Harnblasenkarzinom - mpMRT - VI-RADS - Umfelddiagnostik

Keywords

mpMRI - VI-RADS - bladder cancer - staging

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