基于非增强与增强MRI VI-RADS评分对膀胱癌肌层浸润的诊断效能评估

Comparison of the diagnostic efficiency of non-enhanced and enhanced MR VI-RADS scores in muscle invasion of bladder cancer

目的:比较基于非增强MRI与增强MRI的膀胱影像报告和数据系统(VI-RADS)评分对膀胱癌肌层浸润的诊断效能。方法:回顾性搜集2018年1月至2021年12月期间在我院行盆腔MRI检查并经手术病理证实的尿路上皮癌患者,最终共纳入52例患者(56个病灶)。2位评阅者按照VI-RADS的评分标准,分别对非增强MRI(T_(2)WI+DWI)和常规增强MRI(T_(2)WI+DWI+DCE)进行VI-RADS评分。通过Kappa检验评估2位评阅者之间的一致性,并与病理结果对照分别计算诊断准确率、敏感度、特异度、阳性预测值、阴性预测值及受试者工作特征曲线下面积。结果:25个病灶为肌层浸润,31个病灶无肌层浸润。以4分为阈值,非增强VI-RADS和常规增强VI-RADS在评估膀胱癌肌层浸润与非肌层浸润中的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为87.5%和87.5%、88.0%和92.0%、87.1%和87.1%、96.0%和92.6%、96.8%和93.5%;曲线下面积分别为0.865和0.897。结论:非增强MRI基础上的VI-RADS评估膀胱癌肌层浸润的效能与常规增强MRI相仿。

Objective:To compare the diagnostic performance of vesical imaging reporting and data system(VI-RADS)scoring based on non-enhanced MRI and enhanced MRI in the assessment of bladder cancer myometrial invasion.Methods:Patients with urothelial carcinoma confirmed by pathology who had pelvic multiparametric MRI examination in our hospital from January 2018 to December 2021 were retrospectively reviewed.A total of 52 patients with 56 lesions were finally included.Two readers blindly reviewed VI-RADS for non-enhanced MRI(T_(2)WI+DWI)and VI-RADS for conventional contrast-enhanced MRI(T_(2)WI+DWI+DCE).The consistency between reviewers was evaluated by the Kappa test,and the accuracy,sensitivity,specificity,positive predictive value and negative predictive value were calculated in comparison with the pathological results,and the area under the receiver operating characteristic curve(ROC)was calculated separately.Results:Twenty-five lesions were muscle-invasive bladder cancer and thirty-one lesions were non-muscle-invasive bladder cancer.With a threshold of 4 points,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of non-enhanced VI-RADS and conventional enhanced VI-RADS in evaluating muscle-invasive bladder cancer and non-muscle-invasive bladder cancer were 87.5%and 87.5%,88.0%and 92.0%,87.1%and 87.1%,96.0%and 92.6%,96.8%and 93.5%,respectively.The areas under the ROC of the two were 0.865 and 0.897,respectively.Conclusion:The efficacy of VI-RADS based on non-enhanced MRI in assessing muscle invasion in bladder cancer is comparable with conventional contrast-enhanced MRI.