Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Department of Radiology, Fujian Provincial Hospital, Fuzhou, China.
Cancer Med. 2023 May;12(9):10462-10472. doi: 10.1002/cam4.5782. Epub 2023 Mar 14.
To investigate the value of 3.0T MRI multi-directional diffusion-weighted imaging (DWI) combined with T2WI morphological features and lesion distribution in preoperative prediction of muscle layer invasion of bladder cancer (BC) and the correlation with postoperative Ki-67.
This retrospective study enrolled patients with BC between 2019 and 2021. Patients with muscular invasive bladder cancer (MIBC) or non-muscular invasive BC (NMIBC) were also analyzed by preoperative 3.0T MRI aFostic efficacy.
A total of 186 patients were enrolled. About 27 patients with MIBC (35 lesions in total) and 62 with NMIBC (99 lesions in total). We found the tumor with a larger size, a wide base, and a smaller apparent dispersion coefficient (ADC) value and normalized ADC(nADC) value, without a stalk, presenting a greater risk of muscle invasion. ADC value, nADC value, maximum diameter, and stalk were independently associated with muscle invasion. Lesions located at the bladder fundus or involvement of multiple sites were independently associated with muscle invasion compared to the bladder body. In combination with morphological features, the AUCs of ADC and nADC showed accuracies of 0.925 and 0.947-0.951, respectively. TADC and nTADC showed the best diagnostic efficacy in multiple respects. KI-67 LI was negatively correlated with ADC and nADC values.
This is the first report in which we found Multi-directional DWI combined with T2WI in 3.0T MRI can be used to predict the muscle layer invasion of bladder cancer. ADC values reflect the muscular invasion of bladder cancer and show a moderate negative correlation with Ki-67. It is especially suitable for bladder cancer patients with renal insufficiency or tumor recurrence.
探讨 3.0T MRI 多向扩散加权成像（DWI）联合 T2WI 形态学特征及病灶分布对膀胱癌（BC）术前肌层侵犯的预测价值，并与术后 Ki-67 表达的相关性。
回顾性分析 2019 年至 2021 年期间收治的 BC 患者，对术前 3.0T MRI 进行 aFostic 分析，判断患者是否存在肌层浸润，并分析术前 MRI 与术后 Ki-67 表达的相关性。
共纳入 186 例患者，其中 MIBC 患者 27 例（35 个病灶），NMIBC 患者 62 例（99 个病灶）。结果发现，肿瘤体积较大、基底较宽、表观弥散系数（ADC）值和标准化 ADC（nADC）值较小、无蒂、位置较高者更易发生肌层浸润。ADC 值、nADC 值、最大直径和蒂与肌层浸润有关。与膀胱体相比，肿瘤位于膀胱底部或累及多个部位者更易发生肌层浸润。与形态学特征相结合，ADC 和 nADC 的 AUC 值分别为 0.925 和 0.947-0.951。在多方面，TADC 和 nTADC 显示出最佳的诊断效能。Ki-67 LI 与 ADC 和 nADC 值呈负相关。
这是首次报道 3.0T MRI 多向 DWI 联合 T2WI 可用于预测膀胱癌的肌层侵犯。ADC 值反映膀胱癌的肌层侵犯，与 Ki-67 呈中度负相关，尤其适用于合并肾功能不全或肿瘤复发的膀胱癌患者。
