膀胱影像报告和数据系统对肌层浸润性膀胱癌的预测价值研究

Predicting the risk of muscle-invasive bladder cancer using vesical imaging-reporting and data system

目的探讨膀胱影像报告和数据系统(VI-RADS)在预测膀胱癌肌层浸润方面的准确性和各级评分的临床意义。方法回顾性分析2014年3月至2019年5月收治的59例膀胱肿瘤患者的病例资料,男51例,女8例。年龄36~82岁,中位年龄62岁。患者术前均接受多参数磁共振成像(mpMRI)检查,包含T2加权成像(T2WI)、弥散加权成像(DWI)和动态对比增强MRI(DCE-MRI)。放射科医生按照VI-RADS评分标准对所有患者的mpMRI影像进行阅片评分。患者行mpMRI检查前2周内均未行膀胱灌注治疗,检查后4周内接受手术治疗,34例行经尿道膀胱肿瘤切除术(TURBT),其中7例采用肿瘤整块切除技术;3例行膀胱部分切除术;22例行根治性膀胱切除术。对照病理结果,计算各级VI-RADS评分中肌层浸润性膀胱癌(MIBC)患者的比例,绘制ROC曲线并计算曲线下面积,分析VI-RADS预测膀胱癌肌层浸润的敏感性和特异性。结果本研究59例中,病理诊断为MIBC 18例,非肌层浸润性膀胱癌(NMIBC)41例。肿瘤分期:Ta期27例、T1期14例、T2期11例、T3期6例和T4期1例。VI-RADS1~5分的患者分别为12、27、2、16、2例,各评分中MIBC分别为0例、2例(7.4%)、1例(50.0%)、13例(81.3%)、2例(100.0%)例。ROC曲线显示,以VI-RADS≥3分作为预测MIBC的标准时,其约登指数最大,为0.7913;预测MIBC的敏感性为88.9%,特异性为90.2%,曲线下面积为0.924。结论VI-RADS预测MIBC的准确性高。当VI-RADS≥3分时,应高度警惕膀胱癌肌层浸润可能。

Objective To evaluate the accuracy and clinical significance of the vesical imaging-reporting and data system(VI-RADS)in predicting muscle-invasive bladder cancer(MIBC).Methods The data of 59 bladder cancer patients who underwent multiparametric magnetic resonance imaging and surgery between 2014 March and 2019 May were retrospectively analyzed,which includes 51 males and 8 females,aged 36-82 years old,with a median age of 62 years old.According to the scoring methods specified by VI-RADS,radiologists read and scored all mpMRIs including T2-weighted imaging(T2WI),diffusion-weighted imaging(DWI),and dynamic contrast enhancement MRI(DCE-MRI)of all the included patients.And then the VI-RADS were compared with pathological diagnosis.Proportions of MIBC in each score category were calculated,and ROC curve was plotted and the area under the curve(AUC)was estimated to assess the sensitivity and specificity of VI-RADS in diagnosing MIBC.Results The number of patients in VI-RADS score category 1 to 5 were 12,28,2,15 and 2,respectively.And there were 0,2(7.4%),1(50.0%),13(81.3%),2(100.0%)MIBC patients in each score category,respectively.When VI-RADS≥3 was used to define MIBC,it came to the largest Youden’s Index(0.7913),with an AUC of 0.924.And the sensitivity and specificity were 88.9%and 90.2%,respectively.Conclusions VI-RADS has high accuracy in predicting MIBC,and it is worthy of application and verification in further clinical practice.The urologists should be highly alert to the existence of MIBC when VI-RADS≥3.