使用一种新的磁共振成像策略检测膀胱癌的肌肉侵犯
Detecting Muscle Invasion of Bladder Cancer Using a Proposed Magnetic Resonance Imaging Strategy.
机构信息
Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China.
PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, 430060, China.
出版信息
J Magn Reson Imaging. 2021 Oct;54(4):1212-1221. doi: 10.1002/jmri.27676. Epub 2021 May 17.
BACKGROUND
Accurate evaluation of the invasion depth of tumors with a Vesical Imaging-Reporting and Data System (VI-RADS) score of 3 is difficult.
PURPOSE
To evaluate the diagnostic performance of a new magnetic resonance imaging (MRI) strategy based on the integration of the VI-RADS and tumor contact length (TCL) for the diagnosis of muscle-invasive bladder cancer (MIBC).
STUDY TYPE
Single center, retrospective.
SUBJECTS
A group of 179 patients with a mean age of 67 years (range, 24.0-96.0) underwent multiparametric MRI (mpMRI) before surgery, including 147 (82.1%) males and 32 (17.9%) females. Twenty-four (13.4%), 90 (50.3%), 43 (24.0%), 15 (8.4%), and 7 (3.9%) cases were Ta, T1, T2, T3, and T4, respectively.
FIELD STRENGTH/SEQUENCE: A 1.5 T and 3.0 T, T2-weighted turbo spin-echo (TSE), single-shot echo-planar (SS-EPI), diffusion-weighted imaging (DWI), and T1-weighted volumetric interpolated breath-hold examination (T1-VIBE).
ASSESSMENT
Three radiologists independently graded the VI-RADS score and measured the TCL on index lesion images. A proposed MRI strategy called VI-RADS_TCL was introduced by modifying the VI-RADS score, which was downgraded to VI-RADS 3F (equal to a VI-RADS score of 2) if VI-RADS = 3 and TCL < 3 cm.
STATISTICAL TESTS
Intraclass correlation coefficients (ICCs), Mann-Whitney U test, chi-square tests, receiver operating characteristic (ROC) curves, and 2 × 2 contingency tables were applied.
RESULTS
Inter-reader agreement values were 0.941 (95% CI, 0.924-0.955) and 0.934 (95% CI, 0.916-0.948) for the TCL and VI-RADS score. The TCL was significantly increased in the MIBC group (6.40-6.85 cm) compared with the NMIBC group (1.98-2.45 cm) (P < 0.05). The specificity and positive predictive values (PPV) of VI-RADS_TCL were 82.46%-87.72% and 90.91%-91.59%, which were significantly greater than VI-RADS score (P < 0.05). Additionally, 52.17%-55.88% NMIBC lesions with VI-RADS 3 were downgraded to 3F by using VI-RADS_TCL.
DATA CONCLUSION
The proposed MRI strategy could reduce the false-positive rate of lesions with a VI-RADS score of 3 while retaining sensitivity.
EVIDENCE LEVEL
4 TECHNICAL EFFICACY: 2.
背景
对于 VI-RADS 评分为 3 的肿瘤浸润深度的准确评估较为困难。
目的
评估一种新的基于 VI-RADS 和肿瘤接触长度（TCL）整合的磁共振成像（MRI）策略在诊断肌层浸润性膀胱癌（MIBC）中的诊断性能。
研究类型
单中心，回顾性。
受试者
179 例平均年龄为 67 岁（范围，24.0-96.0）的患者在术前接受了多参数 MRI（mpMRI）检查，包括 147 例（82.1%）男性和 32 例（17.9%）女性。24 例（13.4%）、90 例（50.3%）、43 例（24.0%）、15 例（8.4%）和 7 例（3.9%）分别为 Ta、T1、T2、T3 和 T4。
场强/序列：1.5 T 和 3.0 T、T2 加权涡轮自旋回波（TSE）、单次激发 echo-planar（SS-EPI）、扩散加权成像（DWI）和 T1 加权容积内插屏气检查（T1-VIBE）。
评估
3 位放射科医生独立对 VI-RADS 评分和指数病变图像上的 TCL 进行分级。引入了一种称为 VI-RADS_TCL 的 MRI 策略，即如果 VI-RADS=3 且 TCL<3cm，则将 VI-RADS 评分降低至 VI-RADS 3F（相当于 VI-RADS 评分 2）。
统计检验
应用了组内相关系数（ICC）、Mann-Whitney U 检验、卡方检验、受试者工作特征（ROC）曲线和 2×2 列联表。
结果
TCL 和 VI-RADS 评分的读者间一致性值分别为 0.941（95%CI，0.924-0.955）和 0.934（95%CI，0.916-0.948）。MIBC 组的 TCL（6.40-6.85cm）明显高于 NMIBC 组（1.98-2.45cm）（P<0.05）。VI-RADS_TCL 的特异性和阳性预测值（PPV）分别为 82.46%-87.72%和 90.91%-91.59%，明显高于 VI-RADS 评分（P<0.05）。此外，通过使用 VI-RADS_TCL，52.17%-55.88%的 VI-RADS 评分为 3 的非肌层浸润性膀胱癌病变被降级为 3F。
数据结论
该研究提出的 MRI 策略可以在保持敏感性的同时降低 VI-RADS 评分为 3 的病变的假阳性率。
证据水平
4
技术功效
2
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