CT形态分析对膀胱球形肿瘤肌层浸润情况的预测价值

Morphology study of ball-shaped bladder tumor on CT and its predictive value of muscle invasion

目的:探讨CT形态分析对膀胱球形肿瘤肌层浸润情况的预测价值。方法:回顾性分析51例球形膀胱肿瘤行膀胱全切患者的CT资料及病理检查结果,根据瘤体形态进行分析及分类,对照病理结果分析CT瘤体形态与肿瘤肌层浸润情况的关系。结果:球形肿瘤根据CT形态特点可分为五种类型:Ⅰ型24例,为单纯球形(非肌层浸润23例);Ⅱ型3例,为球形肿瘤周围有低矮片状肿瘤(均非肌层浸润);Ⅲ型12例,为增强后肿瘤内有焰芯样强化(均非肌层浸润);Ⅳ型5例,为肿瘤基底处膀胱壁凹陷(肌层浸润3例);Ⅴ型7例,为伴有同侧输尿管扩张(肌层浸润6例)。本组51例中,根据各型所占例数分析,Ⅰ、Ⅱ、Ⅲ型97.4%(38/39)为非肌层浸润,Ⅳ、Ⅴ型75.0%(9/12)为肌层浸润;如果以此为预测标准,CT对肿瘤肌层浸润情况的判断准确率可达92.2%(47/51)。结论:对于膀胱球形肿瘤,单独通过CT瘤体形态预测判断肿瘤肌层浸润是可行及可靠的。

Objective：To explore the morphology study of ball-shaped bladder tumor on CT and its predictive value of muscle invasion. Method：CT images and pathology results of patients underwent radical cystectomy were reviewed retrospectively. The bladder tumors were analysed by contour on CT images, based on which a classification was made. Comparison was made between tumor shape modality and histologic examination results to conclude a new method for predicting the aggressiveness of bladder cancers. Result： Round-shaped tumors can be divided into five types by shape on CT： Ⅰ simple round tumor alone, Ⅱ round tumor with thin blanket-shaped tumor around, Ⅲ round tumor with a flame-shaped core enhancement, Ⅳ round tumor with a pit in the bladder wall at tumor base, V round tumor with dilation of ipsilateral ureter. Of all the 51 cases enrolled, 97.4% of type Ⅰ , Ⅱ and Ⅲ were non-muscle-invasive and 75.0% of type IV and type V were muscle-invasive. The accuracy may achieve 92.2% in differentiating superficial from muscle-invasive tumor by type Ⅰ , Ⅱ , Ⅲ vs. type Ⅳ,Ⅴ. Conclusion： It is feasible and reliable to predict muscle invasion status by tumor shape on CT.