Zhou Guoxing, Chen Xiao, Zhang Jianhua, Zhu Jingqi, Zong Genlin, Wang Zhongqiu
Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China; Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China.
Eur J Radiol. 2014 Nov;83(11):2013-8. doi: 10.1016/j.ejrad.2014.08.012. Epub 2014 Aug 29.
Diffusion weighted magnetic resonance imaging (DWI) and dynamic contrast-enhanced (DCE) MRI have been considered useful for pathological staging and histological grading in bladder cancer. To our knowledge, no study has combined the two imaging modalities together to assess aggressiveness of bladder cancer.
To assess the clinical aggressiveness of bladder cancer with DCE MRI and DWI at 3.0T.
A total of 59 patients with 69 pathologically confirmed tumor lesions were included in this study. All patients underwent MR examination at 3.0T basing on DWI and DCE imaging. Tumor staging and histological grade were evaluated. The aggressiveness of bladder cancer was classified as low-, intermediate-, or high-aggressiveness according to its pathological phenotype. Apparent diffusion coefficient (ADC) value and semi-quantitative parameters (wash-in rate and wash-out rate) were determined. The correlation between clinical aggressiveness and ADC value, wash-in rate and wash-out rate were analyzed. In addition, the diagnostic accuracy of the diffusion and semi-quantitative parameters were estimated using receiver operating characteristic curve (ROC).
Aggressiveness of bladder cancer is negatively correlated with ADC value (r=-0.705, p<0.0001) and wash-out rate (r=-0.719, p<0.0001). The tumor ADC value is positively correlated with wash-out rate (r=0.555, p<0.0001). The diagnostic specificity and accuracy using tumor ADC value and wash-out for the tumor with size <24mm were better than that tumors with size ≥24mm. The sensitivity, specificity and accuracy of ADC and wash-out rate in combination in diagnosis of bladder cancer aggressiveness were 96.7%, 94.9% and 95.7%, respectively. ROC curve revealed the diagnostic performance of aggressiveness of bladder cancer using ADC value and wash-out rate were 0.928 (cut-off value: 0.905×10(-3)mm(2)/s) and 0.891 (cut-off value: 0.685min(-1)), respectively.
ADC and wash-out rate derived from DWI and DCE-MRI at 3.0T have good potential to assess the aggressiveness of bladder cancer and the accuracy was greater for ADC than for semi-quantitative parameters.
扩散加权磁共振成像（DWI）和动态对比增强（DCE）MRI被认为对膀胱癌的病理分期和组织学分级有用。据我们所知，尚无研究将这两种成像方式结合起来评估膀胱癌的侵袭性。
利用3.0T的DCE MRI和DWI评估膀胱癌的临床侵袭性。
本研究共纳入59例患者的69个经病理证实的肿瘤病灶。所有患者均基于DWI和DCE成像在3.0T进行MR检查。评估肿瘤分期和组织学分级。根据膀胱癌的病理表型将其侵袭性分为低、中、高侵袭性。测定表观扩散系数（ADC）值和半定量参数（注入率和洗脱率）。分析临床侵袭性与ADC值、注入率和洗脱率之间的相关性。此外，使用受试者工作特征曲线（ROC）评估扩散和半定量参数的诊断准确性。
膀胱癌的侵袭性与ADC值（r=-0.705，p<0.0001）和洗脱率（r=-0.719，p<0.0001）呈负相关。肿瘤ADC值与洗脱率呈正相关（r=0.555，p<0.0001）。对于大小<24mm的肿瘤，使用肿瘤ADC值和洗脱率的诊断特异性和准确性优于大小≥24mm的肿瘤。ADC和洗脱率联合诊断膀胱癌侵袭性的敏感性、特异性和准确性分别为96.7%、94.9%和95.7%。ROC曲线显示，使用ADC值和洗脱率诊断膀胱癌侵袭性的性能分别为0.928（临界值：0.905×10(-3)mm(2)/s）和0.891（临界值：0.685min(-1)）。
3.0T的DWI和DCE-MRI得出的ADC和洗脱率具有评估膀胱癌侵袭性的良好潜力，且ADC的准确性高于半定量参数。
