{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:06:25Z","timestamp":1784307985892,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate whether extracellular volume (ECV) fraction derived from contrast\u2010enhanced computed tomography (CT) is associated with recurrence risk in patients with treatment\u2010na\u00efve high\u2010risk non\u2010muscle\u2010invasive bladder cancer (HR\u2010NMIBC) receiving intravesical gemcitabine\/docetaxel (Gem\/Doce) therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study, conducted at a tertiary referral centre, included 103 patients with HR\u2010NMIBC treated with intravesical Gem\/Doce between 2012 and 2024. All patients underwent pre\u2010resection contrast\u2010enhanced CT with an equilibrium phase (~3\u2009min post\u2010injection). Tumour ECV fraction (%) was calculated using the formula: ECV\u2009=\u2009(\u0394HUtumour\/\u0394HUaorta)\u2009\u00d7\u2009(1\u2009\u2212\u2009haematocrit)\u2009\u00d7\u2009100, where \u0394 Hounsfield units (HU) represents the change in attenuation between non\u2010contrast and equilibrium phases. Regions of interest were manually placed in the tumour and abdominal aorta, and haematocrit values obtained within \u00b110\u2009days were used. Associations between clinical variables, ECV, and recurrence were evaluated using Cox proportional hazards models, with discrimination assessed by Uno's C\u2010statistic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median (interquartile range) follow\u2010up was 17\u2009(10\u201325)\u2009months. High\u2010grade recurrence\u2010free survival (HG\u2010RFS) was 76% at 12\u2009months and 69% at 24\u2009months. CT\u2010derived ECV was the only variable significantly associated with HG\u2010RFS (hazard ratio 1.05, 95% confidence interval 1.03\u20131.08), demonstrating strong discrimination (C\u2010statistic, 0.81;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). A 15% threshold offered the best sensitivity\u2013specificity trade\u2010off (~70% each) for predicting HG\u2010RFS at 12 and 24\u2009months. Patients with ECV \u226415% had markedly better HG\u2010RFS than those with ECV &gt;15% at 24\u2009months (88% vs 41%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CT\u2010derived ECV is a practical, first\u2010of\u2010its\u2010kind imaging biomarker associated with recurrence risk and useful for risk stratification in patients with HR\u2010NMIBC treated with intravesical Gem\/Doce, a regimen increasingly used in the setting of global Bacillus Calmette\u2010Gu\u00e9rin shortages and intolerance. ECV can be rapidly quantified from routine contrast\u2010enhanced CT using standard picture archiving and communication system (PACS) tools, without additional imaging or proprietary software, making it a feasible metric for integration into risk\u2010adapted management pending large\u2010scale validation with extended follow\u2010up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70319","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T13:17:08Z","timestamp":1779974228000},"page":"306-314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>Computed tomography<\/scp>\n                    \u2010derived extracellular volume fraction is associated with high\u2010grade recurrence in non\u2010muscle\u2010invasive bladder cancer treated with intravesical gemcitabine and docetaxel"],"prefix":"10.1111","volume":"138","author":[{"given":"Mohamad","family":"Abou Chakra","sequence":"first","affiliation":[{"name":"Department of Urology University of Iowa Health Care  Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa","family":"Alsamarah","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Iowa Health Care  Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Y.","family":"Hougen","sequence":"additional","affiliation":[{"name":"Department of Urology University of Iowa Health Care  Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef","family":"Zakharia","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine Mayo Clinic  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Urology University of Iowa Health Care  Iowa City IA 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