Kong Lingmin, Weng Bei, Cai Qian, Ma Ling, Cao Wenxin, Chen Yanling, Qian Long, Guo Yan, Chen Junxing, Wang Huanjun
Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, PR China (L.K., B.W., Q.C., L.M., W.C., Y.C., Y.G., H.W.).
Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China (L.Q.).
Acad Radiol. 2025 Apr;32(4):2090-2098. doi: 10.1016/j.acra.2024.11.060. Epub 2025 Jan 9.
To investigate the feasibility of amide proton transfer-weighted (APTw) and diffusion-weighted MRI in evaluating the response of bladder cancer (BCa) to neoadjuvant immunochemotherapy.
From June 2021 to July 2023, participants with pathologically confirmed BCa were prospectively recruited to undergo MRI examinations, including APTw and diffusion-weighted MRI before and after neoadjuvant immunochemotherapy. Histogram analysis features (mean, median, and entropy) were extracted from pre- and post-treatment APTw and apparent diffusion coefficient (ADC) maps, respectively. Participants were categorized into pCR (pathological complete response, no residual tumor) and non-pCR groups based on histologic evaluation of post-treatment cystectomy specimens. The diagnostic efficacy of parameters in predicting tumor responsiveness was evaluated by calculating the area under receiver operating characteristic curve (AUC).
Significant differences were found in several imaging biomarkers derived from pre-treatment APTw and diffusion-weighted MRI (P<0.05 for all). The baseline APTw mean values yielded the highest diagnostic performance, with an AUC of 0.85 (AUC: 0.75-0.93), for evaluating tumor responsiveness. For the pCR group, APTw values markedly decreased while ADC values noticeably increased at post-treatment MRI (P<0.05 for all). However, the parameter changes in non-pCR group were not significant (P>0.05 for all).
MRI parametrics derived from APTw and diffusion-weighted MRI can both serve as valuable noninvasive imaging biomarkers for evaluating the efficacy of immunochemotherapy and may be used to guide personalized precision therapy.
探讨酰胺质子转移加权（APTw）和扩散加权磁共振成像（MRI）在评估膀胱癌（BCa）对新辅助免疫化疗反应中的可行性。
2021年6月至2023年7月，前瞻性招募经病理证实的BCa患者，在新辅助免疫化疗前后接受MRI检查，包括APTw和扩散加权MRI。分别从治疗前和治疗后的APTw图及表观扩散系数（ADC）图中提取直方图分析特征（均值、中位数和熵）。根据治疗后膀胱切除标本的组织学评估，将参与者分为pCR（病理完全缓解，无残留肿瘤）组和非pCR组。通过计算受试者操作特征曲线下面积（AUC）评估参数预测肿瘤反应性的诊断效能。
在源自治疗前APTw和扩散加权MRI的几种影像生物标志物中发现了显著差异（所有P<0.05）。基线APTw均值在评估肿瘤反应性方面具有最高的诊断性能，AUC为0.85（AUC：0.75 - 0.93）。对于pCR组，治疗后MRI检查时APTw值显著降低，而ADC值显著升高（所有P<0.05）。然而，非pCR组的参数变化不显著（所有P>0.05）。
源自APTw和扩散加权MRI的MRI参数均可作为评估免疫化疗疗效的有价值的非侵入性影像生物标志物，并可用于指导个性化精准治疗。
