Takeuchi Mitsuru, Higaki Atsushi, Kojima Yuichi, Ono Kentaro, Maruhisa Takuma, Yokoyama Takatoshi, Watanabe Hiroyuki, Yamamoto Akira, Tamada Tsutomu
Department of Radiology, Radiolonet Tokai, Nagoya, Japan.
Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Jpn J Radiol. 2025 Apr;43(4):666-675. doi: 10.1007/s11604-024-01694-1. Epub 2024 Nov 16.
To compare image quality and diagnostic performance among SS-EPI diffusion weighted imaging (DWI), multi-shot (MS) EPI DWI, and reduced field-of-view (rFOV) DWI for muscle-invasive bladder cancer (MIBC).
This retrospective study included 73 patients with bladder cancer who underwent multiparametric MRI in our referral center between August 2020 and February 2023. Qualitative image assessment was performed in 73; and quantitative assessment was performed in 66 patients with maximum lesion diameter > 10 mm. The diagnostic performance of the imaging finding of muscle invasion was evaluated in 47 patients with pathological confirmation of MIBC. T2-weighted imaging, SS-EPI DWI, MS-EPI DWI, rFOV DWI, and dynamic contrast-enhanced imaging were acquired with 3 T-MRI. Qualitative image assessment was performed by three readers who rated anatomical distortion, clarity of bladder wall, and lesion conspicuity using a four-point scale. Quantitative assessment included calculation of SNR and CNR, and grading of the presence of muscle layer invasion according to the VI-RADS diagnostic criteria. Wilcoxon matched pairs signed rank test was used to compare qualitative and quantitative image quality. McNemar test and receiver-operating characteristic analysis were used to compare diagnostic performance.
Anatomical distortion was less in MS-EPI DWI, rFOV DWI, and SS-EPI DWI, in that order with significant difference. Clarity of bladder wall was greater for MS-EPI DWI, SS-EPI DWI, and rFOV DWI, in that order. There were significant differences between any two combinations of the three DWI types, except between SS-EPI DWI and MS-EPI in Reader 1. Lesion conspicuity, diagnostic performance, SNR and CNR were not significantly different among the three DWI types.
Among the three DWI sequences evaluated, MS-EPI DWI showed the least anatomical distortion and superior bladder wall delineation but no improvement in diagnostic performance for MIBC. MS-EPI DWI may be considered for additional imaging if SS-EPI DWI is of poor quality.
比较单次激发回波平面成像扩散加权成像（SS-EPI DWI）、多次激发（MS）EPI DWI和缩小视野（rFOV）DWI对肌层浸润性膀胱癌（MIBC）的图像质量和诊断性能。
这项回顾性研究纳入了2020年8月至2023年2月期间在我们的转诊中心接受多参数MRI检查的73例膀胱癌患者。对73例患者进行了定性图像评估；对66例最大病变直径>10 mm的患者进行了定量评估。在47例经病理证实为MIBC的患者中评估了肌肉浸润影像学表现的诊断性能。使用3T-MRI采集T2加权成像、SS-EPI DWI、MS-EPI DWI、rFOV DWI和动态对比增强成像。由三位阅片者进行定性图像评估，他们使用四点量表对解剖结构扭曲、膀胱壁清晰度和病变显影度进行评分。定量评估包括计算信噪比（SNR）和对比噪声比（CNR），并根据VI-RADS诊断标准对肌肉层浸润情况进行分级。采用Wilcoxon配对符号秩检验比较定性和定量图像质量。采用McNemar检验和受试者操作特征分析比较诊断性能。
MS-EPI DWI、rFOV DWI和SS-EPI DWI的解剖结构扭曲程度依次降低，差异有统计学意义。MS-EPI DWI、SS-EPI DWI和rFOV DWI的膀胱壁清晰度依次更高。三种DWI类型的任意两种组合之间均存在显著差异，但在阅片者1中SS-EPI DWI和MS-EPI之间除外。三种DWI类型之间的病变显影度、诊断性能、SNR和CNR无显著差异。
在评估的三种DWI序列中，MS-EPI DWI的解剖结构扭曲最小，膀胱壁描绘效果最佳，但对MIBC的诊断性能没有改善。如果SS-EPI DWI质量较差，可考虑使用MS-EPI DWI进行额外成像。
