VI-RADS联合IVIM序列在膀胱癌肌层侵犯评估中的价值

孟庆涛; 李军; 蒋会东; 王雪强; 相丽

doi:10.16766/j.cnki.issn.1674-4152.002778

VI-RADS联合IVIM序列在膀胱癌肌层侵犯评估中的价值

doi: 10.16766/j.cnki.issn.1674-4152.002778

1.
安徽医科大学附属滁州医院滁州市第一人民医院影像科，安徽滁州 239001
2.
安徽医科大学附属滁州医院滁州市第一人民医院泌尿科
3.
安徽医科大学附属第二医院影像科，安徽合肥 230601

基金项目:

安徽省教育厅高校自然科学研究项目 KJ2021A 0312

安徽省滁州市科技计划项目(重点研发专项)项目 2020ZN008

详细信息

通讯作者:
孟庆涛，E-mail：13955081740@163.com

中图分类号: R737.14 R814.42
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-14
- 网络出版日期: 2023-02-07

Value of vesical imaging reporting and data system combined with intravoxel incoherent motion sequences in the evaluation of muscle invasion in bladder cancer

1.
Department of Imaging Diagnosis, Chuzhou Hospital Affiliated to Anhui Medical University, the First People' s Hospital of Chuzhou, Chuzhou, Anhui 239001, China

摘要

摘要: 目的探讨膀胱影像报告和数据系统(VI-RADS)及体素内不相干运动(IVIM)在评估膀胱癌肌层浸润中的价值。方法回顾性分析2018年6月—2022年2月在滁州市第一人民医院手术及病理检查证实的膀胱癌患者共50例(52处病灶)，均在本院行膀胱磁共振常规多参数(包括T₂WI、DWI、DCE序列)及IVIM序列扫描，其中，非肌层浸润性膀胱癌(NMIBC)30处病灶，肌层浸润性膀胱癌(MIBC)22处病灶。依据VI-RADS对MR各序列图像进行评分，计算不同截断值诊断MIBC的敏感度、特异度、阳性预测值、阴性预测值及准确率；测量病灶IVIM各参数值(ADC_st、D、D*及f值)；分别绘制ROC曲线评价VI-RADS、IVIM参数及其联合对肌层浸润的诊断效能。结果 IVIM序列内ADC_st、D及f值在NMIBC组均高于MIBC组，差异有统计学意义(均P＜0.01)，其AUC分别为0.904、0.889和0.780(均P＜0.01)。以VI-RADS≥4分作为截断值预测肌层浸润性膀胱癌，约登指数最大，为0.603，AUC为0.871；其联合ADC_st及D值时，约登指数提升为0.636，AUC为0.916。结论 VI-RADS≥4分及ADC_st、D和f值减低均提示膀胱癌侵犯肌层可能性较大，而VI-RADS联合ADC_st及D值组合可明显提高诊断效能。
- 膀胱影像报告和数据系统 /
- 体素内不相干运动 /
- 扩散加权成像 /
- 膀胱癌 /
- 肌层侵犯
Abstract: Objective To investigate the value of vesical imaging reporting and data system (VI-RADS) and intravoxel incoherent motion (IVIM) in the diagnosis of muscle invasive bladder cancer (MIBC). Methods A total of 50 cases (52 tumours) with surgery and pathologically confirmed bladder cancer at the First People' s Hospital of Chuzhou from June 2018 to February 2022 were analysed retrospectively. All patients underwent routine multiparameter MRI scan (including T₂WI, DWI and DCE sequence) and IVIM sequence before surgery. Among the cases, 30 lesions were non-MIBC (NMIBC), and 22 were MIBC. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of different cut-off values in diagnosing MIBC were calculated by scoring MR images according to VI-RADS. IVIM parameters (ADC_st, D, D* and f values) were measured. The diagnostic efficacy of VI-RADS, IVIM parameters and their combinations in muscle invasion was evaluated by receiver operating characteristic (ROC) curve. Results The ADCst, D and f values of the NMIBC group were significantly higher than those of the MIBC group (all P < 0.01), and the areas under curve (AUC) were 0.904, 0.889 and 0.780, respectively (all P < 0.01). Using VI-RADS score ≥ 4 as the cut-off, muscle invasion was predicted with the highest Youden index of 0.603 and AUC of 0.871. When the VI-RADS combined with ADC_st and D values, the Yoden index rose to 0.636, and the AUC was 0.916. Conclusion The VI-RADS ≥ 4 and ADC_st, D and f values decline, which indicate the greater possibility of muscle invasion of bladder cancer, and the combination of VI-RADS and ADC_st and D values can significantly improve the diagnostic efficacy.
- Vesical imaging reporting and data system /
- Intravoxel incoherent motion /
- Apparent diffusion coefficient /
- Bladder cancer /
- Muscle invasive

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图 1 VI-RADS 3分单发病灶

注：A~D为男性患者，75岁。A为T₂WI示膀胱左侧壁肿块，大小为2.4 cm×3.0 cm，邻近肌层低信号尚连续，未见明显增厚，SC3。B、C为DWI示肿块高信号，邻近肌层未见明显高信号，DW3；ADC_st值为1.324×10^-3mm²/s。D为DCE肿块早期明显强化，肌层强化不明显，DC3。VI-RADS 3分，提示NMIBC，与病理一致。

Figure 1. VI-RADS 3 for single-onset lesions

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图 2 VI-RADS 2分单发病灶

注：A~D为男性患者，56岁。A为fs T₂WI示膀胱右侧壁肿块，大小为1.1 cm×1.8 cm，邻近膀胱壁增厚，肌层低信号连续，SC2。B、C为DWI示肿块稍高信号，邻近肌层未见明显高信号，DW2；ADC_st值为1.29×10^-3mm²/s。D为DCE示肿块早期明显强化，相邻肌层早期不强化，DC2。VI-RADS 2分，提示NMIBC，与病理一致。

Figure 2. VI-RADS 2 for single-onset lesions

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图 3 VI-RADS 5分单发病灶

注：A~D为男性患者，50岁。A、B为轴位及冠状位T₂WI示膀胱左侧壁肿块，侵犯肌层及周围组织，大小为6.1 cm×3.3 cm，SC5。C为DWI示相应肿块DWI呈稍高信号，邻近肌层受侵，DW5，ADC_st值为0.756×10^-3mm²/s。D为DCE示肿块早期明显强化，DC5。VI-RADS 5分，提示MIBC，与病理一致。

Figure 3. VI-RADS 5 for single-onset lesions

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图 4 VI-RADS 1分及4分多发病灶

注：A~F为男性患者，86岁。A为fs T₂WI示膀胱两侧后壁肿块，左侧大小为1.7 cm×2.5 cm，邻近肌层低信号欠连续，SC3;右侧0.86 cm×0.87 cm，邻近肌层信号连续，SC1。B为DWI相应肿块呈高信号，左侧肿瘤邻近肌层及输尿管内见高信号，DW4;右侧肌层连续完整，DW1。C、D为左侧肿瘤，ADC_st值为0.898×10^-3mm²/s，D值为0.652×10^-3mm²/s。E、F为右侧肿瘤，ADC_st值为1.290×10^-3mm²/s，D值为0.836×10^-3mm²/s。左、右侧病灶评分为4分及1分，提示左侧MIBC，右侧NMIBC，与病理一致。

Figure 4. VI-RADS 1 and 4 for multi-onset lesions

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图 5 VI-RADS及其联合ADC_st、D值预测MIBC的诊断效能

注：VI-RADS≥4分为截断值(A)及VI-RADS≥4分联合ADC_st、D值(B)预测MIBC效能。

Figure 5. The diagnostic efficacy of VI-RADS and its combined ADCst/D values predict MIBC

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表 1 膀胱癌多参数MRI的VI-RADS评分标准

Table 1. VI-RADS scoring criteria for multiparametric MRI in bladder cancer

T₂WI、DCE、DWI序列	VI-RADS评分
SC 1+DC 1+DWI 1	1分(浸润肌层极不可能存在)
SC 2+DC 2+DWI 2	2分(浸润肌层不太可能存在)
SC 3+DC 2+DWI 2	2分(浸润肌层不太可能存在)
SC 3+DC 3和(或)DWI 3	3分(浸润肌层的存在模棱两可)
SC 3+DC 4和(或)DWI 4	4分(浸润肌层可能存在)
SC 4+DC 4和(或)DWI 4	4分(浸润肌层可能存在)
SC 4+DC 5和(或)DWI 5	5分(浸润肌层极有可能存在)
SC 5+DC 5和(或)DWI 5	5分(浸润肌层极有可能存在)
SC 5+DC 4和(或)DWI 4	4分(浸润肌层极可能存在)

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表 2 NMIBC及MIBC组间IVIM各参数值比较

Table 2. Comparison of IVIM parameters between NMIBC and MIBC groups

组别	病灶数	ADC_st(×10^-3 mm²/s)	D(×10^-3 mm²/s)	f	D*(×10^-3 mm²/s)
NMIBC	30	1.39±0.22	1.03±0.24	0.53±0.14	12.12±6.64
MIBC	22	0.91±0.19	0.67±0.12	0.36±0.17	9.87±5.59
t值		5.112	4.077	4.885	0.445
P值		＜0.001	＜0.001	0.031	0.662

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表 3 IVIM各参数值对MIBC的诊断效能

Table 3. The diagnostic efficacy of IVIM parameters for MIBC

参数	阈值	敏感度(%)	特异度(%)	准确率(%)	AUC	P值
ADC_st	1.18×10^-3 mm²/s	86.51	83.22	85.42	0.904	＜0.001
D	1.07×10^-3 mm²/s	79.62	85.35	83.31	0.889	＜0.001
f	0.41	75.12	71.29	77.62	0.780	0.003

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表 4 不同VI-RADS评分预测MIBC的诊断效能

Table 4. The diagnostic efficacy of different VI-RADS scores to predict MIBC

VI-RADS评分(截断值)	例数	约登指数	敏感度(%)	特异度(%)	PPV(%)	NPV(%)	准确性(%)
≥1分	22	0	100.0	0	42.3	0	42.3
≥2分	22	0.167	100.0	16.7	46.8	100.0	51.9
≥3分	20	0.476	90.9	56.7	60.6	89.5	71.2
≥4分	14	0.603	63.6	96.7	93.3	78.4	82.7
5分	4	0.182	18.2	100.0	100.0	62.5	65.4

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表 5 VI-RADS 2~4分联合ADC_st/D值对MIBC的诊断效能

Table 5. The diagnostic efficacy of VI-RADS 2-4 score combined with ADCst / D value on MIBC

VI-RADS评分	IVIM参数	约登指数	敏感度(%)	特异度(%)
≥2分	ADC_st/D	0.167	100.0	16.7
≥3分	ADC_st/D	0.476	90.9	56.7
≥4分	ADC_st/D	0.636	63.6	100.0

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