School of Cancer and Enabling Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
Eur J Radiol. 2013 Dec;82(12):2161-8. doi: 10.1016/j.ejrad.2013.08.008. Epub 2013 Aug 15.
Treatment of muscle-invasive bladder cancer with chemotherapy results in haemorrhagic inflammation, mimicking residual tumour on conventional MR images and making interpretation difficult. The aim of this study was to use dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to estimate descriptive and tracer kinetic parameters post-neoadjuvant chemotherapy and to investigate whether parameters differed in areas of residual tumour and chemotherapy-induced haemorrhagic inflammation (treatment effect, Tr-Eff).
Twenty-one patients underwent DCE-MRI scans with 2.5s temporal resolution before and following neoadjuvant chemotherapy. Regions-of-interest (ROIs) were defined in areas suspicious of residual tumour on T2-weighted MRI scans. Data were analysed semi-quantitatively and with a two-compartment exchange model to obtain parameters including relative signal intensity (rSI80s) and plasma perfusion (Fp) respectively. The bladder was subsequently examined histologically after cystectomy for evidence of residual tumour and/or Tr-Eff. Differences in parameters measured in areas of residual tumour and Tr-Eff were examined using Student's t-test.
Twenty-four abnormal sites were defined after neoadjuvant chemotherapy. On pathology, 10 and 14 areas were identified as residual tumour and Tr-Eff respectively. Median rSI80s and Fp were significantly higher in areas of residual tumour than Tr-Eff (rSI80s = 2.9 vs 1.7, p < 0.001; Fp = 20.7 vs 9.1 ml/100ml/min, p = 0.03). The sensitivity and specificity for differentiating residual tumour from Tr-Eff were 70% and 100% (rSI80s), 60% and 86% (Fp), and 75% and 100% when combined.
DCE-MRI parameters obtained post-treatment are capable of distinguishing between residual tumour and treatment effect in patients treated for bladder cancer with neoadjuvant chemotherapy.
化疗治疗肌肉浸润性膀胱癌会导致出血性炎症，在常规磁共振图像上模拟残留肿瘤，使解释变得困难。本研究旨在使用动态对比增强磁共振成像（DCE-MRI）来估计新辅助化疗后描述性和示踪剂动力学参数，并研究参数在残留肿瘤和化疗诱导的出血性炎症（治疗效果，Tr-Eff）区域是否存在差异。
21 名患者在新辅助化疗前后进行了具有 2.5s 时间分辨率的 DCE-MRI 扫描。在 T2 加权磁共振扫描上可疑残留肿瘤的区域定义了感兴趣区（ROI）。数据分别进行半定量分析和双室交换模型分析，以获得包括相对信号强度（rSI80s）和血浆灌注（Fp）在内的参数。随后在膀胱镜检查后对膀胱进行组织学检查，以寻找残留肿瘤和/或 Tr-Eff 的证据。使用 Student's t 检验检查在残留肿瘤和 Tr-Eff 区域测量的参数差异。
新辅助化疗后定义了 24 个异常部位。在病理学上，10 个和 14 个区域分别被确定为残留肿瘤和 Tr-Eff。残留肿瘤区域的 rSI80s 和 Fp 中位数明显高于 Tr-Eff（rSI80s=2.9 比 1.7，p<0.001；Fp=20.7 比 9.1 ml/100ml/min，p=0.03）。rSI80s（70%和 100%）、Fp（60%和 86%）和联合使用时（75%和 100%），用于区分残留肿瘤和 Tr-Eff 的灵敏度和特异性。
新辅助化疗治疗膀胱癌后获得的 DCE-MRI 参数能够区分残留肿瘤和治疗效果。
