肿瘤周围强化在鉴别肌层浸润性和非肌层浸润性膀胱癌中的诊断意义
Diagnostic significance of peritumoral enhancement in distinguishing between muscle-invasive and non-muscle-invasive bladder cancer.
作者信息
Takeuchi Mitsuru, Higaki Atsushi, Kojima Yuichi, Ono Kentaro, Maruhisa Takuma, Yokoyama Takatoshi, Watanabe Hiroyuki, Yamamoto Akira, Tamada Tsutomu
机构信息
Radiolonet Tokai, Nagoya, Japan.
Kawasaki Medical School, Kurashiki, Japan.
出版信息
Abdom Radiol (NY). 2025 Apr;50(4):1679-1688. doi: 10.1007/s00261-024-04658-1. Epub 2024 Oct 30.
OBJECTIVE
The aim of this study was to assess the prevalence of peritumoral enhancement (PTE) in patients with muscle-invasive bladder cancer (MIBC) and non-MIBC (NMIBC) and to propose a modified diagnostic criterion for Vesical Imaging Reporting and Data System (VI-RADS) that incorporates PTE.
MATERIALS AND METHODS
This retrospective study included 95 patients with bladder cancer (age, 72 ± 11; 77 men; 36 MIBCs and 59 Non-MIBCs) who underwent multiparametric MRI in our referral center between 2011 and 2023. The images were interpreted by four radiologists. The readers classified the possibility of muscle layer invasion into categories 1-5, based on the VI-RADS categorical diagnostic criterion. PTE was defined as a linear contrast enhancement observed at the edge of tumor invasion which is convex outward from the normal bladder wall and contrasts more than the normal muscle layer and tumor. A modified VI-RADS that upgrades the final VI-RADS category to 4 if PTE is present when the original VI-RADS category is 3 or less was proposed. The frequency of PTE in the MIBC and NMIBC groups was compared using the Fisher's exact test. Sensitivity and specificity for the diagnosis of MIBC were compared with the original VI-RADS using McNemar test. Pathologic diagnosis was used as the reference standard.
RESULTS
PTE was present in 70-81% (25/36-29/36) of MIBC and absent in 92-98% (54/59-58/59) of non-MIBC. For all readers, the PTE was significantly more frequent (p < 0.001) in the MIBC group than the NMIBC group. The sensitivities of modified VI-RADS (75.0-86.1%) were significantly higher than those of original VI-RADS (41.7-55.6%) (p = 0.002-0.008). The specificity of modified VI-RADS (91.5-98.3%) were not statistically different from original VI-RADS (98.3-100%).
CONCLUSIONS
In conclusion, PTE is a highly specific finding for MIBC. modified VI-RADS incorporating PTE increases sensitivity for MIBC.
目的
本研究旨在评估肌层浸润性膀胱癌（MIBC）和非肌层浸润性膀胱癌（NMIBC）患者瘤周强化（PTE）的发生率，并提出一种纳入PTE的改良膀胱影像报告和数据系统（VI-RADS）诊断标准。
材料与方法
本回顾性研究纳入了2011年至2023年期间在我们的转诊中心接受多参数MRI检查的95例膀胱癌患者（年龄72±11岁；男性77例；36例MIBC和59例NMIBC）。图像由四名放射科医生解读。根据VI-RADS分类诊断标准，读者将肌层浸润的可能性分为1-5类。PTE定义为在肿瘤浸润边缘观察到的线性对比增强，其从正常膀胱壁向外凸出，且对比程度超过正常肌层和肿瘤。提出了一种改良的VI-RADS，如果原始VI-RADS类别为3或更低且存在PTE，则将最终VI-RADS类别升级为4。使用Fisher精确检验比较MIBC组和NMIBC组中PTE的发生率。使用McNemar检验将改良VI-RADS诊断MIBC的敏感性和特异性与原始VI-RADS进行比较。病理诊断用作参考标准。
结果
MIBC患者中70-81%（25/36-29/36）存在PTE，NMIBC患者中92-98%（54/59-58/59）不存在PTE。对于所有读者，MIBC组中PTE的发生率显著高于NMIBC组（p<0.001）。改良VI-RADS的敏感性（75.0-86.1%）显著高于原始VI-RADS（41.7-55.6%）（p=0.002-0.008）。改良VI-RADS的特异性（91.5-98.3%）与原始VI-RADS（98.3-100%）无统计学差异。
结论
总之，PTE是MIBC的高度特异性表现。纳入PTE的改良VI-RADS提高了MIBC的诊断敏感性。
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