基于VI-RADS和ADC直方图分析术前预测膀胱癌肌层浸润的价值  

Value of VI-RADS and ADC histogram analysis in preoperative prediction of myometrial invasion of bladder cancer

作　　者：龚姝卉 黄俊[1] 陈慧 窦娅芳 龚志刚[1] 张敏[1] GONG Shuhui;HUANG Jun;CHEN Hui;DOU Yafang;GONG Zhigang;ZHANG Min(Department of Radiology,Shuguang Hosptial,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院影像科,上海200021

出　　处：《影像诊断与介入放射学》2024年第4期250-257,共8页Diagnostic Imaging & Interventional Radiology

摘　　要：目的本研究旨在探讨膀胱影像报告和数据系统(VI-RADS)和体积表观扩散系数(ADC)直方图参数评估膀胱癌肌层浸润的价值,并探讨两者的相关性。方法回顾性分析81例经尿道膀胱肿瘤电切术或根治性膀胱切除术病理证实的膀胱癌患者,由两名放射科医生运用VI-RADS评分方法对病灶进行标准化评分。从ADC图中获得每个病变的体积ADC直方图参数,比较VI-RADS及量化参数在肌层浸润性膀胱癌(MIBC)和非肌层浸润性膀胱癌(NMIBC)间的差异,对有意义的参数绘制受试者工作特征曲线评估各模型的预测能力。结果最终纳入40例(49.4%)肌层浸润性膀胱癌,41例(50.6%)非肌层浸润性膀胱癌,53个(65.4%)病灶VI-RADS大于等于3分,28个(34.6%)病灶VI-RADS小于3分。在所有参数中,VI-RADS的曲线下面积(AUC)值最高(AUC=0.903)。ADC_(min)、ADC_(media)、ADC_(mean)、10%ADC(第10百分位数ADC值)、25%ADC(第25百分位数ADC值)、75%ADC(第75百分位数ADC值)、90%ADC(第90百分位数ADC值)的数值MIBC组低于NMIBC组,且与VI-RADS评分呈负相关(r=-0.439、-0.526、-0.305、-0.368、-0.547、-0.527、-0.396,P均<0.05);峰度、熵MIBC组高于NMIBC组,与VI-RADS评分呈正相关(r=0.593、0.296,P均<0.05)。VI-RADS+75%ADC、VI-RADS+ADC_(media)、VI-RADS+ADC_(mean)与单独使用VI-RADS相比有统计学差异(P值分别为0.038、0.018、0.029),其中结合ADC_(media)的VI-RADS获得了最大的AUC值(AUC=0.950)。结论VI-RADS和体积ADC直方图分析可有助于判定膀胱癌是否肌层浸润,同时两者存在一定相关性,体积ADC直方图可以为VI-RADS提供进一步的信息补充。Objective To explore the diagnostic accuracy and correlation of Vesical Imaging-Reporting and Data System(VI-RADS)and apparent diffusion coefficient(ADC)value histogram in muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC).Methods Multiparametric MRI of 81 patients with pathologically confirmed bladder cancer after transurethral resection of bladder tumors or radical cystectomy was retrospectively analyzed.Two radiologists scored all MRI examinations according to the VI-RADS criteria and ADC histogram parameters were obtained.Differences of VI-RADS and quantitative parameters between MIBC and NMIBC were evaluated.The diagnostic performance of the VI-RADS,ADC histogram parameter with statistically significant difference and combined diagnosis were evaluated for predictive ability of each model using the receiver operating characteristic(ROC)curves.Results Of 81 patients including 40(49.4%)MIBC and 41(50.6%)NMIBC,53(65.4%)lesions with VI-RADS≥3 points,and 28(34.6%)lesions with VI-RADS<3 points were analyzed.VI-RADS had the highest area under the ROC curve(AUC)of 0.903 among all parameters.The ADC_(min),ADC_(media)n,ADC_(mean),10%ADC(10th percentile ADC value),25%ADC(25th percentile ADC value),75%ADC(75th percentile ADC value),90%ADC(90th percentile ADC value)of MIBC were significantly lower than those of NMIBC and were negatively correlated with the VI-RADS score(r=-0.439,-0.526,-0.305,-0.368,-0.547,-0.527,-0.396,all P<0.05)whereas kurtosis and entropy of MIBC were significantly higher than that of NMIBC and had positive correlation with the VI-RADS score(r=0.593,0.296;P<0.05).VI-RADS+75%ADC(P=0.038),VI-RADS+ADC_(media)n(P=0.018),and VI-RADS+ADC_(mean)(P=0.029)showed statistical differences compared to VI-RADS alone with the highest AUC value obtained by combining ADC_(media)n with VI-RADS(AUC=0.950).Conclusion VI-RADS and ADC histogram analysis can effectively discriminate between MIBC and NMIBC.ADC histogram can supplement VI-RADS.

关 键 词：膀胱癌 肌层浸润 磁共振成像 膀胱影像报告和数据系统 表观扩散系数 

分 类 号：R737.14[医药卫生—肿瘤] R445.2[医药卫生—临床医学]