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| 磁共振高分辨率T2加权成像联合分段读出平面回波成像鉴别诊断肌层和非肌层浸润性膀胱癌的临床价值 |
| 陈海虎1,阳青松1,边云1,史张1,刘芳1,方旭1,张振声2,陆建平1,许传亮2,王莉1* |
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(1. 海军军医大学(第二军医大学) 长海医院影像医学科, 上海 200433;
2. 海军军医大学(第二军医大学) 长海医院泌尿外科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 评估磁共振高分辨率T2加权成像（HR-T2WI）、分段读出平面回波成像（RS-EPI）和两者联合鉴别肌层与非肌层浸润性膀胱癌的临床价值。方法 前瞻性纳入2016年6月至2017年12月于我院经膀胱镜活组织检查证实为膀胱癌、最终行手术治疗并明确病理分期的9 5例患者，所有患者均行HR-T2WI、RS-EPI检查。分别应用HR-T2WI、RS-EPI及HR-T2WI+RS-EPI图像明确膀胱癌是否浸润肌层，并采用Kappa检验将3种方法的诊断结果与病理结果进行比较。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评估3种诊断方法的灵敏度、特异度和准确度，采用DeLong检验对3种诊断方法的AUC进行两两比较。结果 HR-T2WI、RS-EPI和HR-T2WI+RS-EPI的诊断结果与病理结果的一致性均较好，Kappa值分别为0.770、0.787、0.936（P均<0.01）。3种方法鉴别肌层与非肌层浸润性膀胱癌的AUC、灵敏度、特异度和准确度分别为0.899、95.5%（42/44）、82.4%（42/51）和88.4%（84/95），0.891、84.1%（37/44）、94.1%（48/51）和89.5%（85/95），以及0.966、93.2%（41/44）、100.0%（51/51）和96.8%（92/95）。HR-T2WI+RS-EPI鉴别诊断肌层与非肌层浸润性膀胱癌的AUC大于HR-T2WI和RS-EPI（Z=-2.627 8、-2.720 5，P=0.008 6、0.006 5）。结论 HR-T2WI联合RS-EPI可作为术前无创、准确鉴别诊断肌层和非肌层浸润性膀胱癌的方法。 |
| 关键词: 高分辨率T2加权成像 分段读出平面回波成像 膀胱肿瘤 磁共振成像 |
| DOI：10.16781/j.0258-879x.2018.05.0543 |
| 投稿时间：2018-03-28修订日期：2018-04-22 |
| 基金项目: |
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| Clinical value of high-resolution T2-weighted magnetic resonance imaging combined with readout-segmented echo-planar imaging in differential diagnosis of muscle and non-muscle invasive bladder cancer |
| CHEN Hai-hu1,YANG Qing-song1,BIAN Yun1,SHI Zhang1,LIU Fang1,FANG Xu1,ZHANG Zhen-sheng2,LU Jian-ping1,XU Chuan-liang2,WANG Li1* |
(1. Department of Medical Imaging, Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the clinical value of high-resolution T2-weighted magnetic resonance imaging (HR-T2WI), readout-segmented echo-planar imaging (RS-EPI) and HR-T2WI plus RS-EPI in differentiating non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). Methods A prospective study was conducted on 95 patients with bladder cancer identified by cystoscope biopsy, who underwent surgery treatment in our hospital from Jun. 2016 to Dec. 2017. All 95 patients had clear pathological staging, and received HR-T2WI and RS-EPI examination. NMIBC and MIBC were differentiated using HR-T2WI, RS-EPI and HR-T2WI plus RS-EPI, and the diagnosis results were compared with the pathological results using Kappa test. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) of ROC was calculated to evaluate the sensitivity, specificity, accuracy of HR-T2WI, RS-EPI and HR-T2WI plus RSEPI. DeLong test was used to compare the AUC of three methods. Results The diagnostic results of HR-T2WI, RS-EPI and HRT2WI plus RS-EPI had good agreement with the pathological results (Kappa=0.770, 0.787 and 0.936; all P<0.01). The AUC, sensitivity, specificity and accuracy of HR-T2WI, RS-EPI and HR-T2WI plus RS-EPI were 0.899, 95.5% (42/44), 82.4% (42/51) and 88.4% (84/95), 0.891, 84.1% (37/44), 94.1% (48/51) and 89.5% (85/95), and 0.966, 93.2% (41/44), 100.0% (51/51) and 96.8% (92/95), respectively. The AUC of HR-T2WI+RS-EPI was higher than that of HR-T2WI and RS-EPI (Z=-2.627 8 and -2.720 5, P=0.008 6 and 0.006 5). Conclusion HR-T2WI plus RS-EPI can be used as a preoperative non-invasive examination method to differentiate NMIBC and MIBC. |
| Key words: high-resolution T2-weighted imaging readout-segmented echo-planar imaging bladder neoplasms magnetic resonance imaging |
