基于表观扩散系数异质性及形态学指标评估非肌层浸润性膀胱癌病理分级  

Assessment of pathological grading in non-muscle invasive bladder cancer based on apparent diffusion coefficient heterogeneity and morphological indicators

作　　者：秦乙菡 周思妤 吴宇涛 李月玥 石健 王小林[2] 冯峰[1] QIN Yihan;ZHOU Siyu;WU Yutao;LI Yueyue;SHI Jian;WANG Xiaolin;FENG Feng(Department of Radiology,the Affiliated Tumor Hospital of Nantong University,Nantong,Jiangsu Province 226000,China;Department of Urology Surgery,the Affiliated Tumor Hospital of Nantong University,Nantong,Jiangsu Province 226000,China)

机构地区：[1]南通大学附属肿瘤医院放射科,江苏南通226000 [2]南通大学附属肿瘤医院泌尿外科,江苏南通226000

出　　处：《实用放射学杂志》2025年第3期447-451,共5页Journal of Practical Radiology

摘　　要：目的 探讨表观扩散系数(ADC)异质性与形态学指标联合评估非肌层浸润性膀胱癌(NMIBC)病理分级的价值.方法 回顾性分析86例经手术病理证实为NMIBC的 MRI图像.所有患者均接受T2WI、扩散加权成像(DWI)和动态对比增强(DCE)检查.2位放射科医师独立测量肿瘤最大径(LD)、肿瘤与膀胱壁实际接触面长度(ACTCL)、平均ADC(ADCmean)值、最小ADC(ADCmin)值、最大ADC(ADCmax)值.ADC异质性通过(ADCmax-ADCmin)/ADCmean计算得出.采用Mann-Whitney U检验比较低、高级别NMIBC间各定量参数间的差异,卡方检验比较其定性参数间的差异.单、多因素logistic回归分析用于筛选高级别NMIBC的独立预测因子,绘制受试者工作特征(ROC)曲线评价 ADC异质性联合形态学指标评估高级别NMIBC的效能.结果 ADC异质性和ACTCL是术前评估NMIBC病理分级的独立预测因子.ADC异质性、ACTCL评估高级别NMIBC的曲线下面积(AUC)分别为0.843和0.744,两者联合的AUC为0.902,差异有统计学意义(P<0.05).结论 ADC异质性联合ACTCL能有效提高术前评估NMIBC病理分级的效能,为临床提供更明确的诊疗决策及预后监测.Objective To explore the value of combining apparent diffusion coefficient(ADC)heterogeneity with morphological indicators in assessing the pathological grading of non-muscle invasive bladder cancer(NMIBC).Methods The MRI images of 86 patients confirmed with NMIBC by surgical pathology were analyzed retrospectively.All patients underwent T2WI,diffusion weighted imaging(DWI),and dynamic contrast enhancement(DCE)examinations.Two radiologists independently measured tumor largest diameter(LD),actual tumor-wall contact length(ACTCL),ADCmean,ADCmin,and ADCmax values.ADC heterogeneity was calculated using the formula(ADCmax-ADCmin)/ADCmean.Differences in quantitative parameters between low-and high-grade NMIBC were compared using the Mann-Whitney U test,while differences in qualitative parameters were compared using the chi-square test.Univariate and multivariate logistic regression analyses were used to identify independent predictors of high-grade NMIBC,and receiver operating characteristic(ROC)curves were drawn to evaluate the performance of ADC heterogeneity combined with morphological indicators in assessing high-grade NMIBC.Results ADC heterogeneity and ACTCL were independent predictors for preoperative assessment of NMIBC pathological grading.The area under the curve(AUC)of ADC heterogeneity and ACTCL in assessing high-grade NMIBC were 0.843 and 0.744,respectively.The combined AUC was 0.902.The difference was statistically significant(P<0.05).Conclusion The combination of ADC heterogeneity with ACTCL can effectively improve the efficiency of preoperative assessment of NMIBC pathological grading,and providing more precise clinical decision-making and prognosis monitoring.

关 键 词：非肌层浸润性膀胱癌 病理分级 扩散加权成像 形态学 

分 类 号：R737.14[医药卫生—肿瘤] R446.8[医药卫生—临床医学] R445.2