Zhang Xiaoxian, Wang Shaoyu, Wang Mengzhu, Wang Lifeng, Zhang Shouning, Chen Xuejun, Xu Chunmiao
Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China (X.Z., L.W., S.Z., X.C., C.X.).
MR Research Collaboration, Siemens Healthineers, Shanghai 201318, China (S.W., M.W.).
Acad Radiol. 2025 May 26. doi: 10.1016/j.acra.2025.05.014.
To evaluate the diagnostic performance of diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), mean apparent propagator (MAP), neurite orientation dispersion and density imaging (NODDI), and the Vesical Imaging-Reporting and Data System (VI-RADS) in discriminating the pathological grade of bladder urothelial carcinoma (UCB).
This prospective study enrolled patients with pathologically confirmed UCB between May 2023 and December 2023. Preoperative MRI protocols included spin-echo echo-planner imaging (SE-EPI) and conventional DWI. Quantitative parameters from SE-EPI (DTI, DKI, MAP, NODDI) and apparent diffusion coefficient (ADC) values were measured. Group comparisons between low-grade and high-grade UCB were performed using t-tests or Mann-Whitney U tests. Receiver operating characteristic (ROC) analysis and DeLong's test were used to evaluate diagnostic performance.
A total of 50 patients with UCB (low-grade/ high-grade = 16/34) were included. VI-RADS score and mean kurtosis (MK) derived from DKI emerged as independent predictors for differentiating low-grade and high-grade UCB (area under the curve (AUC): 0.692 and 0.865, respectively). The combination of VI-RADS and DKI-MK achieved superior diagnostic performance (AUC: 0.915, sensitivity: 0.941) compared to VI-RADS alone (AUC: 0.692, sensitivity: 0.471; p < 0.001) or ADC alone (AUC: 0.787, sensitivity: 0.813; p < 0.05).
Integrating VI-RADS with DKI-MK significantly enhances preoperative assessment of UCB pathological grading, demonstrating higher accuracy and sensitivity than VI-RADS or ADC alone. This approach improves diagnostic objectivity by combining qualitative imaging criteria with quantitative diffusion metrics, offering potential clinical utility for treatment stratification.
评估扩散张量成像（DTI）、扩散峰度成像（DKI）、平均表观传播子（MAP）、神经突方向离散度与密度成像（NODDI）以及膀胱影像报告和数据系统（VI-RADS）在鉴别膀胱尿路上皮癌（UCB）病理分级方面的诊断性能。
本前瞻性研究纳入了2023年5月至2023年12月期间病理确诊为UCB的患者。术前MRI方案包括自旋回波平面回波成像（SE-EPI）和传统扩散加权成像（DWI）。测量了SE-EPI的定量参数（DTI、DKI、MAP、NODDI）和表观扩散系数（ADC）值。采用t检验或曼-惠特尼U检验对低级别和高级别UCB进行组间比较。采用受试者操作特征（ROC）分析和德龙检验评估诊断性能。
共纳入50例UCB患者（低级别/高级别=16/34）。VI-RADS评分和DKI得出的平均峰度（MK）成为区分低级别和高级别UCB的独立预测因子（曲线下面积（AUC）分别为0.692和0.865）。与单独使用VI-RADS（AUC：0.692，灵敏度：0.471；p<0.001）或单独使用ADC（AUC：0.787，灵敏度：0.813；p<0.05）相比，VI-RADS与DKI-MK的联合具有更好的诊断性能（AUC：0.915，灵敏度：0.941）。
将VI-RADS与DKI-MK相结合可显著提高UCB病理分级的术前评估，显示出比单独使用VI-RADS或ADC更高的准确性和灵敏度。这种方法通过将定性成像标准与定量扩散指标相结合提高了诊断的客观性，为治疗分层提供了潜在的临床应用价值。
