Nguyen Huyen T, Pohar Kamal S, Jia Guang, Shah Zarine K, Mortazavi Amir, Zynger Debra L, Wei Lai, Clark Daniel, Yang Xiangyu, Knopp Michael V
From the *Wright Center of Innovation in Biomedical Imaging, Departments of Radiology, †Urology, ‡Internal Medicine, §Pathology, and ∥Center for Biostatistics, The Ohio State University, Columbus, OH.
Invest Radiol. 2014 Jun;49(6):390-5. doi: 10.1097/RLI.0000000000000022.
The objective of this study was to assess the capability of T2-weighted magnetic resonance imaging (T2W-MRI) and the additional diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) using multitransmit 3 T in the localization of bladder cancer.
This prospective study was approved by the local institutional review board. Thirty-six patients were included in the study and provided informed consent. Magnetic resonance imaging scans were performed with T2W-MRI and DCE-MRI on a 3-T multitransmit system. Two observers (with 12 and 25 years of experience) independently interpreted T2W-MRI before DCE-MRI data (maps of pharmacokinetic parameters) to localize bladder tumors. The pathological examination of cystectomy bladder specimens was used as a reference criteria standard. The McNemar test was performed to evaluate the differences in sensitivity, specificity, and accuracy. Scores of κ were calculated to assess interobserver agreement.
The sensitivity, specificity, and accuracy of the localization with T2W-MRI alone were 81% (29/36), 63% (5/8), and 77% (34/44) for observer 1 and 72% (26/36), 63% (5/8), and 70% (31/44) for observer 2. With additional DCE-MRI available, these values were 92% (33/36), 75% (6/8), and 89% (39/44) for observer 1 and 92% (33/36), 63% (5/8), and 86% (38/44) for observer 2. Dynamic contrast-enhanced MRI significantly (P<0.01) improved the sensitivity and accuracy for observer 2. For the 23 patients treated with chemotherapy, DCE-MRI also significantly (P<0.02) improved the sensitivity and accuracy of bladder cancer localization with T2W-MRI alone for observer 2. Scores of κ were 0.63 for T2W-MRI alone and 0.78 for additional DCE-MRI. Of 7 subcentimeter malignant tumors, 4 (57%) were identified on T2W images and 6 (86%) were identified on DCE maps. Of 11 malignant tumors within the bladder wall thickening, 6 (55%) were found on T2W images and 10 (91%) were found on DCE maps.
Compared with conventional T2W-MRI alone, the addition of DCE-MRI improved interobserver agreement as well as the localization of small malignant tumors and those within bladder wall thickening.
本研究的目的是评估T2加权磁共振成像（T2W-MRI）的能力以及使用多发射3T动态对比增强磁共振成像（DCE-MRI）在膀胱癌定位中的附加诊断价值。
本前瞻性研究经当地机构审查委员会批准。36例患者纳入研究并签署知情同意书。在3T多发射系统上进行T2W-MRI和DCE-MRI磁共振成像扫描。两名观察者（分别有12年和25年经验）在DCE-MRI数据（药代动力学参数图）之前独立解读T2W-MRI以定位膀胱肿瘤。膀胱切除标本的病理检查用作参考标准。采用McNemar检验评估敏感性、特异性和准确性的差异。计算κ评分以评估观察者间的一致性。
观察者1单独使用T2W-MRI定位的敏感性、特异性和准确性分别为81%（29/36）、63%（5/8）和77%（34/44），观察者2分别为72%（26/36）、63%（5/8）和70%（31/44）。有了额外的DCE-MRI后，观察者1的这些值分别为92%（33/36）、75%（6/8）和89%（39/44），观察者2分别为92%（33/36）、63%（5/8）和
