Faculty of Medicine, Tanta University, Tanta, Gharbia Governorate, Egypt.
Diagnostic Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Dakahlia Governorate, Egypt.
Can Assoc Radiol J. 2019 Aug;70(3):254-263. doi: 10.1016/j.carj.2018.11.004. Epub 2019 Mar 25.
The aim of study is to assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and correlation with tumour angiogenesis in evaluation of urinary bladder cancer.
The study included 81 patients with recent presumed diagnosis of bladder tumour or who came for follow up after management of histopathologically proven bladder cancer. All had DCE-MRI with time-signal intensity curve. The radiologic results then correlated with the histopathologic results using both haematoxylin and eosin stain and immuno-histochemical staining for localization and evaluation of CD34 immunoreactivity as a detector for the microvessel density (MVD) and tumour angiogenesis.
Seventy-one cases were pathologically proven to be malignant: 41 cases (58%) showed type III time-signal intensity curve (descending); 22 cases (31%) showed type II (plateau); and 8 cases (11%) showed type I (ascending) curve. The sensitivity of DCE-MRI in stage T1 bladder tumour was 80%; in stage T2, it was (90.9%); and in stage T3, it was (96.9%). Overall accuracy of DCE-MRI in tumour staging was 89.5% and P = .001 (significant). Values more than the cutoff value = 76.13 MVD are cystitis with sensitivity (90%), specificity (91%), and P value is .001, which is statistically highly significant.
There is a strong positive association between DCE-MRI (staging and washout slope of the time-signal intensity curve) with histopathologic grade, tumour stage, and MVD in bladder cancer. So, DCE-MRI can be used as reliable technique in preoperative predictions of tumour behavior and affect the planning of antiangiogenetic therapy.
本研究旨在评估动态对比增强磁共振成像（DCE-MRI）在膀胱癌评估中的作用及其与肿瘤血管生成的相关性。
本研究纳入了 81 例近期疑似膀胱癌患者或经组织病理学证实的膀胱癌治疗后随访患者。所有患者均行 DCE-MRI 检查，并绘制时间-信号强度曲线。然后，使用苏木精和伊红染色以及免疫组织化学染色，对放射学结果与组织病理学结果进行相关性分析，以定位和评估 CD34 免疫反应性，作为微血管密度（MVD）和肿瘤血管生成的检测指标。
71 例患者的病理结果证实为恶性肿瘤：41 例（58%）表现为 III 型时间-信号强度曲线（下降型）；22 例（31%）表现为 II 型（平台型）；8 例（11%）表现为 I 型（上升型）曲线。DCE-MRI 在 T1 期膀胱癌中的敏感度为 80%；在 T2 期为 90.9%；在 T3 期为 96.9%。DCE-MRI 对肿瘤分期的总体准确率为 89.5%，P 值为.001（具有统计学意义）。超过截断值（=76.13 MVD）的值与膀胱炎的敏感度（90%）、特异性（91%）相关，P 值为.001，具有统计学显著意义。
DCE-MRI（分期和时间-信号强度曲线的洗脱斜率）与膀胱癌的组织病理学分级、肿瘤分期和 MVD 之间存在强烈的正相关关系。因此，DCE-MRI 可作为术前预测肿瘤行为的可靠技术，并影响抗血管生成治疗的规划。
