الفهرس 
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Abstract
Ultrasonographic diagnosis of urinary bladder carcinoma
can be subdivided into two problems : 1- Tumour detection
(including the differential diagnosis), and 11- Tumour
.taging. Exophytic bladder carcinomas appear as intraluminal
polypoidal filling defects projecting from the echogenic
bladder wall into the anechoic bladder lumen. They are
hypoechoic compared to the echogenic bladder wall and do not
alter their location on changing patient position. Larger
tumours have complex architecture due to haemorrhage and
necrosis. Superficial non-infiltrating tumours give an
impression of mucosal irregularities without distortion or
fixation of the bladder wall with sharp demarcation between
the tumour and the adjacent normal mucosa. ~hey have well
defined base. Infiltrating tumours cause disrruption of the
echogenic bladder wall beneath the tumour with dimenution of
the bladder capacity. The tend to have broader base.
Extravesical extension shows features of infitrative tumoure
and in addition irregular masses are present in the
surrounding pelvic,tissues.
Concering the ultrasonographic staging of urinary bladder
carcinoma both Jewett-Strong-Marshal and TNlolclassifications
are used. The ultrasonographic findings based on rigidity and
continuity of the bladder wall as well as the reduction of the
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bladder capacity. More recently, the degree of tumour
iniltration into the bladder wall is exposed under various
levels of amplifier gain. Accordingly, ladder tumours can be
cla.sified as follow:
- Superficial tumours (Ta - ’1’1):the echOOense bladder wall
underlying the less echogenic tumour appear smooth and
uninterrupted without deformity or reduction of the bladder
capacity.
- Tumours infiltrating the bladder wall (’1’2 - T3a) : the
echodense bladder wall is interrupted without deformity or
reduction of the bladder capacity.
- Tumours extending beyond the bladder wall· (T3b - ’1’4):the
perivesical tissue is involved by the hypoechoic tumour tissue
with deformity of the wall and reduction of the bladder
capacity. The perivesical structures may be involved.
The internal iliac lymph nodes are the most common sites
of metastases. Pelvic lymphadenopathy are often detected by
transabdominal approach. The main role of transuretheral
scanning is useful in evaluatingthe primary tumour and to
monitor the depth of transuretheral resection of a bladder
tumour. Transrectal and transuretheral scanning can offer
informations concerning the conditions of the baldder wall e.g
detecting the degree of tumour infiltration.
An overall accuracy of only 62 \ in evaluating bladder
tumours by ultrasound. This accuracy rate is related to the
size and location of the tumour. The detection accuracy for
tWllOurs less than 5 IDDI in diameter was as low as 33.3\
compared to 83.3% for those between 1-2 cm and 95% for those
more than 2 cm diameter. A low accuracy rate was observed for
tumours located in bladder neck and dome in contrast to those
located on the posterior and lateral walls.