Below the Belt Award

Bladder cancer is a highly aggressive disease with poor outcomes despite advances in technology. For cancers that invade the muscle wall of the bladder (i.e., T2 disease), the 5-year survival even with radical treatment is only 60%. Currently, T-staging is achieved via endoscopic resection of the tumour (TURBT). Unfortunately, Australian studies have shown that such endoscopic resections fail to sample the muscular layer in 41.9% of cases and in 39.7% of high-risk specimens, despite being the gold-standard for T-staging. Similar rates are seen in the international literature. These patients who are under staged have delayed treatment and poor outcomes. The early identification of T2 and T3 (i.e., muscle invasive) disease is critical to trigger early radical treatment and use of neo-adjuvant chemotherapy. CT scans and ultrasounds are completely unable to differentiate non-muscle invasive (T1 or lower) from muscle invasive (T2 or higher) disease. mp-MRI has the potential to improve the accuracy of clinical Tstaging. Previous MRI studies in bladder cancer have been limited by reserving the use of mpMRI to the post-resection setting, where the accuracy of MRI is confounded by postsurgical inflammation. Furthermore, no studies have assessed the use of novel MRI imaging sequences, such as diffusion kurtosis imaging, that have shown promise in detecting the grade and aggressiveness of other tumours. In this study, we will assess: (i) the accuracy of MRI in detecting muscle invasive bladder cancer that requires radical treatment; (ii) the ability of MRI to determine organ confined disease vs locally advanced disease >T3; (ii) the ability of MRI to discriminate bladder cancer from other masses seen on CT or U/S; (iii) To assess concordance between “kurtosis score” and histopathological grade of tumour; (iv) To assess concordance between “kurtosis score” and T-stage of tumour.