连续时间随机行走扩散模型联合膀胱影像报告与数据系统诊断膀胱癌肌层浸润状态的研究  

Integrating the continuous-time random-walk diffusion model and the vesical imaging-reporting and data system to predict muscle invasion of bladder cancer

作　　者：王玮[1] 李玮[1] 杨俊哲[1] 吴静云[1] 邱建星[1] Wang Wei;Li Wei;Yang Junzhe;Wu Jingyun;Qiu Jianxing(Department of Radiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院医学影像科,北京100034

出　　处：《中华放射学杂志》2024年第4期394-400,共7页Chinese Journal of Radiology

摘　　要：目的探讨连续时间随机行走(CTRW)扩散模型联合膀胱影像报告与数据系统(VI-RADS)对膀胱癌肌层浸润的诊断效能。方法本研究为病例对照研究,回顾性收集2022年8月至2023年3月于北京大学第一医院经病理证实的64例膀胱尿路上皮癌患者,根据术后病理结果分为肌层浸润性膀胱癌(MIBC)组和非肌层浸润性膀胱癌(NMIBC)组,分别为29例和35例。所有患者术前4周内完成膀胱MRI,包括T_(2)WI、常规扩散加权成像(DWI)及多b值DWI。采用CTRW模型得到3个定量扩散参数,即扩散常数D_(m)、反映时间和空间扩散异质性的α和β。通过单指数模型计算表观扩散系数(ADC)。基于T_(2)WI和常规DWI对膀胱癌进行VI-RADS评分。MIBC组与NMIBC组间扩散参数比较采用Mann-Whitney U检验,使用logistic回归方法建立联合参数,以受试者操作特征曲线下面积(AUC)评价参数对膀胱癌肌层浸润的诊断效能,采用DeLong检验比较AUC的差异。结果MIBC组与NMIBC组间ADC、D m和α值差异有统计学意义(Z=-2.31、-2.91、-3.97,P=0.021、0.004、<0.001),β值差异无统计学意义(Z=1.69,P=0.091)。D_(m)、α值诊断膀胱癌肌层浸润的AUC(95%CI)分别为0.712(0.587~0.838)、0.790(0.676~0.904),高于ADC值的AUC(AUC为0.669,95%CI 0.537~0.801),差异有统计学意义(Z=2.86、2.27,P=0.004、0.023)。CTRW联合参数(D m+α)的AUC(95%CI)为0.782(0.661~0.876),高于ADC的AUC(Z=2.35,P=0.019)。VI-RADS评分的AUC(95%CI)为0.823(0.716~0.930),VI-RADS联合CTRW参数(VI-RADS+D m+α)的AUC(95%CI)为0.900(0.799~0.961),差异有统计学意义(Z=2.16,P=0.031)。结论CTRW扩散模型参数D m、α对于膀胱癌肌层浸润的诊断效能优于单指数模型的ADC值,且对VI-RADS评分具有补充诊断价值。ObjectiveTo investigate the diagnostic performance of continuous-time random-walk(CTRW)diffusion model combined with vesical imaging-reporting and data system(VI-RADS)in the diagnosis of muscle invasion of bladder cancer.MethodsIn this case-control study,64 patients with pathologically confirmed bladder urothelial carcinoma in Peking University First Hospital were retrospectively enrolled from August 2022 to March 2023.The patients were divided into the muscle invasive bladder cancer(MIBC)group and the nonmuscle invasive bladder cancer(NMIBC)group(29 cases and 35 cases,respectively)according to the pathological results.All patients underwent bladder MRI within 4 weeks before surgery,including T_(2)WI,conventional diffusion weighted imaging(DWI),and multi-b-value DWI.The CTRW model was used to obtain three quantitative diffusion parameters,including D m(an anomalous diffusion coefficient),α(related to temporal diffusion heterogeneity),andβ(related to spatial diffusion heterogeneity).The apparent diffusion coefficient(ADC)was calculated using a mono-exponential model.The VI-RADS scores were evaluated based on T_(2)WI and conventional DWI.The Mann-Whitney U test was used to compare the diffusion parameters between the MIBC group and the NMIBC group.The combination of the parameters was investigated with logistic regression analysis.The diagnostic performance for muscle invasion of bladder cancer was evaluated by receiver operating characteristic analysis and the area under the curve(AUC).The difference between AUC was compared using the DeLong test.ResultsThere were statistically significant differences in ADC,D_(m),andαbetween the MIBC group and the NMIBC group(Z=-2.31,-2.91,-3.97,P=0.021,0.004,<0.001).No significant difference was found inβbetween the two groups(Z=1.69,P=0.091).The AUC(95%CI)of D m andαfor diagnosing MIBC were 0.712(0.587-0.838)and 0.790(0.676-0.904)respectively,both of which were higher than that of ADC(AUC 0.669,95%CI 0.537-0.801)with statistically significant differences(Z=2.86,2.27,P=0.00

关 键 词：膀胱肿瘤 磁共振成像 扩散模型 肌层浸润 膀胱影像报告与数据系统 

分 类 号：R737.14[医药卫生—肿瘤] R730.44[医药卫生—临床医学]