背景:虫征是弥散加权磁共振成像(DWI-MRI)的发现,可用于更好地对肌肉浸润性(MIBC)和非肌肉浸润性膀胱癌(NMIBC)的T分期进行分层。DWI上无中断的低粘膜下信号,定义为虫号(IS),表示NMIBC。
目的:我们旨在确定IS在原发性膀胱癌中的诊断准确性,并在泌尿科医师和放射科医师之间达成一致。
方法:在2018年12月至2020年12月之间,我们回顾性分析了95例经尿道电切术前接受多参数MRI检查的原发性膀胱癌患者。有膀胱癌病史的患者,肿瘤小于10毫米,和核磁共振没有适当的协议,以及没有参加随访的患者,被排除在外。总的来说,71例患者的图像由一名泌尿生殖专科放射科医师和两名泌尿科医师评估。灵敏度,特异性,IS和VI-RADS在区分MIBC和NMIBC方面的阳性和阴性预测值,分析了放射科医师和泌尿科医师之间的相互关系。
结果:随访期间,38例(53.5%)为IS阳性,而33例患者(46.5%)为阴性。在33例IS阴性患者中,14例(42.4%)患者患有MIBC。同时,38例IS阳性患者中有2例(5.3%)患有MIBC(p=0.00).灵敏度,特异性,IS预测MIBC的阳性预测值和阴性预测值分别为87.5%,63.6%,41.2%和94.6%,分别。泌尿科医师和放射科医师之间的观察者共识几乎是完美的(K=0.802和K=0.745)。
结论:DWI上不存在IS有助于区分MIBC和NMIBC。这是一个简单的发现,可以由泌尿科医生解释。
BACKGROUND: Inchworm sign is a finding on diffusion-weighted magnetic resonance imaging (DWI-MRI) and is used to better stratify T-staging in muscle invasive (MIBC) and non-muscle-invasive bladder cancer (NMIBC). An uninterrupted low submucosal signal on DWI, defined as inchworm sign (IS), indicates NMIBC.
OBJECTIVE: We aimed to define the diagnostic accuracy of IS in primary bladder cancer, as well as find agreement between the urologists and the radiologist.
METHODS: Between December 2018 and December 2020, we retrospectively analyzed 95 primary bladder cancer patients who had undergone multiparametric-MRI before transurethral resection. Patients with former bladder cancer history, tumors smaller than 10 mm, and MRI without proper protocol, as well as patients who did not attend follow-up, were excluded. In total, 71 patients\' images were evaluated by a genitourinary specialist radiologist and two urologists. Sensitivity, specificity, positive and negative predictive values of IS and VI-RADS in differentiating MIBC and NMIBC, and interreader agreement between the radiologist and urologists were analyzed.
RESULTS: During follow-up, 38 patients (53.5%) were IS-positive, while 33 patients (46.5%) were negative. Among the 33 patients with negative IS, 14 patients (42.4%) had MIBC. Meanwhile, two out of the 38 IS-positive patients (5.3%) had MIBC (p = 0.00). Sensitivity, specificity, and positive and negative predictive values of IS in predicting MIBC were 87.5%, 63.6%, 41.2%and 94.6%, respectively. The interobserver agreement between the urologists and radiologist was almost perfect ( K = 0.802 and K = 0.745).
CONCLUSIONS: The absence of IS on DWI is useful in differentiating MIBC from NMIBC. It is a simple finding that can be interpreted by urologists.