3.0T磁共振功能成像在术前诊断肌层浸润性膀胱癌的价值  

Using 3.0T MRI to the Preoperative Diagnosis of Muscular Invasive Bladder Cancer

作　　者：夏威利 王立峰 张孝先 许春苗 曲金荣 黎海亮 张首宁 张宏凯 陈学军 XIA Weili;WANG Lifeng;ZHANG Xiaoxian(XIA Weili,WANG Lifeng,ZHANG Xiaoxian,Affiliated Tumor Hospital of Zhengzhou University,450008,P. R. China Affiliated Tumor Hospital of Zhengzhou University,450008,P. R. China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)放射科

出　　处：《临床放射学杂志》2018年第11期1860-1864,共5页Journal of Clinical Radiology

基　　金：河南省科技公关项目(编号:182102310180)

摘　　要：目的评估3.0T磁共振功能成像在术前诊断肌层浸润性膀胱癌(MIBC)的应用价值。方法搜集本院经术后病理证实的84例膀胱癌患者的MRI资料,由2名医师应用T2WI序列、T2WI+DWI序列以及T2WI+DWI+DCE-MRI序列三种方法分别判断膀胱癌是否浸润肌层。绘制受试者工作特征曲线(ROC)分析上述三种方法诊断MIBC的能力。测量病灶相邻膀胱壁肌层表观扩散系数(ADC)值并绘制ROC曲线,分析膀胱癌病灶相邻肌层的ADC值与诊断MIBC的关系。结果甲、乙医师使用T2WI序列、T2WI+DWI序列、T2WI+DWI+DCE-MRI序列诊断MIBC的准确率分别为71.4%、79.2%、91.6%及69.0%、78.6%、90.5%。测量MIBC病灶相邻浸润肌层的ADC值为(1.36±0.15)×10^-3mm^2/s,未浸润的相邻肌层为(2.02±0.39)×10^-3mm^2/s。绘制ROC曲线分析,当ADC值的阈值为1.52×10^-3mm^2/s时,诊断MIBC的敏感度、特异度均高,分别为92.9%、85.2%。结论对比T2WI序列,增加DWI及DCE-MRI序列能够提高诊断MIBC的准确率。测量膀胱癌病灶相邻肌层的ADC值,以1.52×10^-3mm^2/s为阈值诊断MIBC具有较大的应用价值,此阈值可作为术前诊断MIBC的指标,有一定的临床指导意义。Objective To evaluate the value of 3. 0T MRI imaging in the preoperative diagnosis of invasive bladdercancer. Methods 84 consecutive patients with bladder cancer were enrolled in this study. Two experienced radiologists( observer 1 and observer 2) independently evaluated the muscular invasion of bladder cancer on conventional T 2 WI,onT 2 WI + DWI,and onT 2 WI + DWI + DCE-MRI in a blind manner. Receiver operator characteristic ( ROC) curve analyseswere performed to evaluate the diagnostic performance for T 2 WI only,T 2 WI + DWI and T 2 WI + DWI + DCE-MRI. Measurethe apparent diffusion coefficient ( ADC) value of local lesions adjacent to muscular layer of bladder wall,analyze the ADCvalue of these lesions by the ROC curve,and calculate the sensitivity and specificity for diagnosis of muscular invasion.Results The accuracy of the diagnosis with T 2 WI alone,T 2 WI + DWI and T 2 WI + DWI + DCE-MRI were71. 4%,79. 2%and 91. 6% for observer 1 and 69. 0%,78. 6% and 90. 5% for observer 2. The ADC value of muscular layer in muscularinvasive bladder cancer was ( 1. 36 ±0. 15) ×10^-3 mm^2/s,the non - muscular invasive bladder cancer was ( 2. 02 ±0. 39)×10^-3 mm^2/s. With ADC value of 1. 52 ×10^-3 mm^2/s as the threshold the sensitivity and specificity of ADC for the diag-nosis of muscular invasion were 92. 9% and 85. 2%. Conclusion Conventional T 2 W-MRI combined with DWI and DCE-MRI can improve the diagnostic performance of muscular invasion of bladder cancer than conventional T 2 W-MRI alone.Quantitative measurement of ADC value in muscular layer adjacent to lesions is of higher accuracy in diagnosing muscularinvasion of bladder wall. When setting ADC value of 1. 52 ×10^-3 mm^2/s as the threshold,the sensitivity and specificity ofADC for the diagnosis of muscular invasion are relatively higher. This threshold can be used as an indicator of preoperativediagnosis of muscular invasive bladder cancer,has clinical significance.

关 键 词：膀胱肿瘤 扩散加权成像 动态增强磁共振 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.14[医药卫生—诊断学]