肌层浸润性膀胱癌：利用扩散加权磁共振成像对新辅助化疗反应进行预处理预测
Muscle-invasive bladder cancer: pretreatment prediction of response to neoadjuvant chemotherapy with diffusion-weighted MR imaging.
作者信息
Zhang Xinxin, Wang Yichen, Zhang Jin, Xu Xiaojuan, Zhang Lianyu, Zhang Miaomiao, Xie Lizhi, Shou Jianzhong, Chen Yan
机构信息
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 7 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Division of Life Sciences and Medicine, Department of Radiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China.
出版信息
Abdom Radiol (NY). 2022 Jun;47(6):2148-2157. doi: 10.1007/s00261-022-03455-y. Epub 2022 Mar 20.
PURPOSE
To investigate the usefulness of diffusion-weighted MR imaging with ADC value and histogram analysis of ADC in the prediction of response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC).
METHODS
Fifty-eight consecutive patients with clinical T2-4aN0M0 MIBC who underwent MRI before and after NAC were enrolled in the prospective study. The evaluation of response to NAC was based on the pathologic T (pT) stage after surgery. Patients with non-muscle-invasive residual cancer (pTa, pTis, pT1) were defined as responders, while those with muscle-invasive residual cancer (≥ pT2) were defined as non-responders. The ADC value measured from a single-section region of interest and ADC histogram parameters derived from whole-tumor volume of interest in responder and non-responder were compared using the Mann-Whitney U test or independent samples t test. ROC curve analysis was used to evaluate the diagnostic performance of ADC value and ADC histogram parameters in predicting the response to NAC.
RESULTS
The pretreatment ADC value of responders ([1.33 (± 0.21)] × 10mm/s) was significantly higher than that of non-responders ([1.09 (± 0.08)] × 10mm/s) (P < .001). Most of the pretreatment ADC histogram parameters (Mean, 10th, 25th, 50th, 75th, and 90th percentiles) of responders were significantly higher than that of non-responders (P < .001). The AUC was highest for the pretreatment ADC value (0.88; 95% confidence interval: 0.77, 0.95; P < .001).
CONCLUSION
Diffusion-weighted MR imaging with ADC value and histogram analysis of ADC are useful to predict NAC response in patients with MIBC.
目的
探讨扩散加权磁共振成像（MRI）结合表观扩散系数（ADC）值及ADC直方图分析在预测肌层浸润性膀胱癌（MIBC）患者新辅助化疗（NAC）疗效中的作用。
方法
58例连续的临床T2-4aN0M0期MIBC患者在NAC前后接受了MRI检查，纳入前瞻性研究。NAC疗效评估基于术后病理T（pT）分期。非肌层浸润性残留癌（pTa、pTis、pT1）患者定义为反应者，而肌层浸润性残留癌（≥pT2）患者定义为无反应者。使用Mann-Whitney U检验或独立样本t检验比较反应者和无反应者从单层面感兴趣区测得的ADC值以及从全肿瘤感兴趣区得出的ADC直方图参数。采用ROC曲线分析评估ADC值和ADC直方图参数预测NAC疗效的诊断性能。
结果
反应者的治疗前ADC值（[1.33（±0.21）]×10⁻³mm²/s）显著高于无反应者（[1.09（±0.08）]×10⁻³mm²/s）（P＜0.001）。反应者的大多数治疗前ADC直方图参数（均值、第10、25、50、75和90百分位数）显著高于无反应者（P＜0.001）。治疗前ADC值的曲线下面积（AUC）最高（0.88；95%置信区间：0.77，0.95；P＜0.001）。
结论
扩散加权MRI结合ADC值及ADC直方图分析有助于预测MIBC患者的NAC疗效。
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