Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, Hubei, China.
Abdom Radiol (NY). 2021 Sep;46(9):4301-4310. doi: 10.1007/s00261-021-03091-y. Epub 2021 Apr 28.
The objective of this study was to explore whether volumetric apparent diffusion coefficient (ADC) histogram analysis can provide additional value to Vesical Imaging Reporting and Data System (VI-RADS) in differentiating muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC).
80 patients were retrospectively reviewed with pathologically proven NMIBC (n = 53) or MIBC (n = 27). All patients underwent MRI including diffusion-weighted imaging (DWI) (b = 0, 800 s/mm), and the VI-RADS score was evaluated based on DWI. Volumetric ADC histogram parameters were calculated from the volumetric of interest (VOI) on DWI, including the min ADC, mean ADC, median ADC, max ADC, 10th, 25th, 75th, 90th percentiles ADC, skewness, kurtosis, and entropy. The Mann-Whitney U-test was used to compare histogram parameters between NMIBC and MIBC. Receiver operating characteristic analysis was used to evaluate the diagnostic value of each significant parameter.
Among all parameters, the VI-RADS yield the highest Area Under the Curve (AUC, 0.88; sensitivity, 88.89%; specificity, 83.61%). MIBC had significantly lower min ADC, mean ADC, median ADC, 10th, 25th, 75th, and 90th percentiles ADC than NMIBC (p = 0.002, p < 0.001, p < 0.001, p = 0.003, p = 0.004, p < 0.001, p < 0.001). Skewness and kurtosis of MIBC were significantly higher than those of NMIBC (p < 0.001, p < 0.001). The combination of VI-RADS and skewness showed significantly higher AUC (AUC 0.923; 95% CI 0.847-0.969) than only with VI-RADS (AUC 0.880; 95% CI 0.793-0.940).
Volumetric ADC histogram analysis and VI-RADS are both useful methods in differentiating MIBC from NMIBC, and the volumetric ADC histogram analysis can provide additional value to VI-RADS.
本研究旨在探讨膀胱影像报告和数据系统（VI-RADS）评分结合表观扩散系数（ADC）直方图分析是否能为鉴别肌层浸润性膀胱癌（MIBC）和非肌层浸润性膀胱癌（NMIBC）提供更多的价值。
回顾性分析 80 例经病理证实的 NMIBC（n=53）和 MIBC（n=27）患者。所有患者均行 MRI 检查，包括扩散加权成像（DWI）（b=0、800s/mm），并基于 DWI 评估 VI-RADS 评分。从 DWI 的感兴趣容积（VOI）中计算 ADC 直方图参数，包括 min ADC、mean ADC、median ADC、max ADC、10%、25%、75%、90% ADC、偏度、峰度和熵。采用 Mann-Whitney U 检验比较 NMIBC 和 MIBC 之间的直方图参数。采用受试者工作特征（ROC）分析评估各显著参数的诊断价值。
所有参数中，VI-RADS 曲线下面积（AUC）最大（0.88；敏感度 88.89%，特异性 83.61%）。与 NMIBC 相比，MIBC 的 min ADC、mean ADC、median ADC、10%、25%、75%和 90% ADC 显著更低（p=0.002、p<0.001、p<0.001、p=0.003、p=0.004、p<0.001、p<0.001）。MIBC 的偏度和峰度显著高于 NMIBC（p<0.001、p<0.001）。与仅 VI-RADS 相比，VI-RADS 联合偏度的 AUC 显著更高（0.923；95%CI 0.847-0.969）。
ADC 直方图分析和 VI-RADS 评分都是鉴别 MIBC 和 NMIBC 的有用方法，ADC 直方图分析可对 VI-RADS 评分提供额外的价值。
