Zhang Xiaoxian, Yun You, Wang Shaoyu, Wang Mengzhu, Zhang Shouning, Yang Dong, Chen Xuejun, Xu Chunmiao
Department of radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China.
MR Research Collaboration, Siemens Healthineers, Shanghai, China.
Acad Radiol. 2025 Feb;32(2):844-854. doi: 10.1016/j.acra.2024.09.056. Epub 2024 Oct 10.
To predict the muscular invasion status of bladder urothelial carcinoma (UCB) using quantitative parameters from multi-directional high b-value diffusion-weighted imaging (MDHB-DWI), and compare these parameters with the Vesical Imaging Reporting and Data System (VI-RADS).
In this prospective study, patients with pathologically confirmed UCB were enrolled between May 2023 and May 2024. All participants underwent preoperative MRI, including MDHB-DWI and conventional MRI. The average quantitative parameter values of MDHB-DWI (diffusion kurtosis imaging [DKI], diffusion tensor imaging [DTI], mean apparent propagator [MAP] and neurite orientation dispersion and density imaging [NODDI]) and apparent diffusion coefficient (ADC) values were compared between non-muscle invasive (NMIBC) and muscle-invasive (MIBC) groups using the T-test or rank sum test. Quantitative MRI models were developed using multivariate logistic regression analyses based on significant diffusion parameters obtained from MDHB-DWI. Receiver operating characteristic (ROC) curves were plotted, and DeLong's test was applied to compare the area under the curve (AUC) of the model with that of VI-RADS.
A total of 76 patients with UCB (56 males; NMIBC/MIBC=51/25) were included. Axial diffusivity (AD) from DKI and mean diffusivity (MD) from DTI were identified as independent predictors for constructing a quantitative MRI model. The AUC of the model was 0.936, significantly outperforming VI-RADS (AUC=0.831) (p = 0.007).
DKI-AD and DTI-MD from MDHB-DWI demonstrate a robust ability to differentiate muscular invasion in UCB. Their combination significantly improves diagnostic efficiency compared to VI-RADS.
利用多方向高b值扩散加权成像（MDHB-DWI）的定量参数预测膀胱尿路上皮癌（UCB）的肌层浸润状态，并将这些参数与膀胱影像报告和数据系统（VI-RADS）进行比较。
在这项前瞻性研究中，纳入了2023年5月至2024年5月期间经病理证实为UCB的患者。所有参与者均接受术前MRI检查，包括MDHB-DWI和传统MRI。使用T检验或秩和检验比较非肌层浸润性（NMIBC）和肌层浸润性（MIBC）组之间MDHB-DWI的平均定量参数值（扩散峰度成像[DKI]、扩散张量成像[DTI]、平均表观扩散 propagator[MAP]和神经突方向离散度与密度成像[NODDI]）以及表观扩散系数（ADC）值。基于从MDHB-DWI获得的显著扩散参数，使用多变量逻辑回归分析建立定量MRI模型。绘制受试者操作特征（ROC）曲线，并应用DeLong检验比较模型的曲线下面积（AUC）与VI-RADS的曲线下面积。
共纳入76例UCB患者（56例男性；NMIBC/MIBC = 51/25）。DKI的轴向扩散率（AD）和DTI的平均扩散率（MD）被确定为构建定量MRI模型的独立预测因子。该模型的AUC为0.936，显著优于VI-RADS（AUC = 0.831）（p = 0.007）。
MDHB-DWI的DKI-AD和DTI-MD在区分UCB肌层浸润方面具有强大能力。与VI-RADS相比，它们的组合显著提高了诊断效率。
