背景:膀胱成像报告和数据系统(VI-RADS)是使用多参数(mp)MRI对膀胱癌分期进行标准化成像和报告的途径。
目的:研究形态学(MOR)测量对VI-RADS的额外作用,以通过mpMRI检测肌肉浸润性膀胱癌(MIBC)。
方法:回顾性。
方法:共198例患者(72例MIBC和126例NMIBC)接受膀胱mMRI。
■具有快速自旋回波序列的3.0T/T2加权成像,自旋回波平面扩散加权成像和具有快速3D梯度回波序列的动态对比增强成像。
结果:VI-RADS评分和MOR测量,包括肿瘤位置,number,茎,花椰菜状表面,肿瘤生长类型,肿瘤-肌肉接触边缘(TCM),肿瘤纵向长度(TLL),和肿瘤细胞含量指数(TCI)由三名城市放射科医生(3年,8年,15年膀胱MRI的经验,分别)对组织病理学视而不见。
方法:通过具有比值比(OR)的单变量和多变量逻辑回归(LR)分析,检验了与MIBC相关的显着MOR测量值。使用DeLong's测试和决策曲线分析(DCA)的受试者工作特征曲线下面积(AUC)比较未调整与调整VI-RADS。P值<0.05被认为具有统计学意义。
结果:TCM(OR9.98;95%置信区间[CI]4.77-20.8),TCI(OR5.72;95%CI2.37-13.8),在多变量LR分析中,TLL(OR3.35;95%CI1.40-8.03)与MIBC独立相关。经三个MOR调整的VI-RADS获得了显着更高的AUC(读者10.908vs.0.798;读者20.906与0.855;读者30.907vs.0.831),并且在DCA时比未调整的VI-RADS具有更好的临床益处。特别是在VI-RADS定义的模棱两可的病变中,基于MOR的调整导致55.5%(25/45),70.4%(38/54),三位读者的MIBC鉴别准确率提高了46.4%(26/56),分别。
结论:MOR测量提高了VI-RADS在使用mpMRI检测MIBC方面的性能,尤其是模棱两可的病变。
方法:3技术效果:阶段2。
BACKGROUND: Vesical Imaging-Reporting and Data System (VI-RADS) is a pathway for the standardized imaging and reporting of bladder cancer staging using multiparametric (mp) MRI.
OBJECTIVE: To investigate additional role of morphological (MOR) measurements to VI-RADS for the detection of muscle-invasive bladder cancer (MIBC) with mpMRI.
METHODS: Retrospective.
METHODS: A total of 198 patients (72 MIBC and 126 NMIBC) underwent bladder mpMRI was included.
UNASSIGNED: 3.0 T/T2-weighted imaging with fast-spin-echo sequence, spin-echo-planar diffusion-weighted imaging and dynamic contrast-enhanced imaging with fast 3D gradient-echo sequence.
RESULTS: VI-RADS score and MOR measurement including tumor location, number, stalk, cauliflower-like surface, type of tumor growth, tumor-muscle contact margin (TCM), tumor-longitudinal length (TLL), and tumor cellularity index (TCI) were analyzed by three uroradiologists (3-year, 8-year, and 15-year experience of bladder MRI, respectively) who were blinded to histopathology.
METHODS: Significant MOR measurements associated with MIBC were tested by univariable and multivariable logistic regression (LR) analysis with odds ratio (OR). Area under receiver operating characteristic curve (AUC) with DeLong\'s test and decision curve analysis (DCA) were used to compared the performance of unadjusted vs. adjusted VI-RADS. A P-value <0.05 was considered statistically significant.
RESULTS: TCM (OR 9.98; 95% confidence interval [CI] 4.77-20.8), TCI (OR 5.72; 95% CI 2.37-13.8), and TLL (OR 3.35; 95% CI 1.40-8.03) were independently associated with MIBC at multivariable LR analysis. VI-RADS adjusted by three MORs achieved significantly higher AUC (reader 1 0.908 vs. 0.798; reader 2 0.906 vs. 0.855; reader 3 0.907 vs. 0.831) and better clinical benefits than unadjusted VI-RADS at DCA. Specially in VI-RADS-defined equivocal lesions, MOR-based adjustment resulted in 55.5% (25/45), 70.4% (38/54), and 46.4% (26/56) improvement in accuracy for discriminating MIBC in three readers, respectively.
CONCLUSIONS: MOR measurements improved the performance of VI-RADS in detecting MIBC with mpMRI, especially for equivocal lesions.
METHODS: 3 TECHNICAL EFFICACY: Stage 2.