多参数磁共振VI-RADS系统对膀胱癌肌层浸润的预测价值

Predictive value of multi-parameter magnetic resonance imaging using vesical imaging-reporting and data system for muscle invasive in bladder cancer

目的评估基于多参数磁共振的膀胱影像-报告和数据系统(vesical imaging-reporting and data system,VI-RADS)对膀胱癌肌层浸润与否的诊断预测价值。方法收集重庆大学附属肿瘤医院2017年1月至2021年3月行多参数磁共振检查并完成经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)或根治性膀胱切除术的278例膀胱病变患者临床资料;不同影像学医师分别进行磁共振VI-RADS评分,Kappa检验其一致性;分析VI-RADS评分与病理结果的吻合度;采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析VI-RADS各评分诊断肌层浸润性膀胱癌的效能;比较不同手术方式获取的病理组织与VI-RADS评分吻合度。结果两位影像评估者VI-RADS评分一致性较好(符合率为79.86%,Kappa值=0.7508,P<0.001)。ROC曲线分析显示,VI-RADS评分≥3时预测肌层浸润性膀胱癌的曲线下面积为0.774,约登指数为54.78%,敏感度为96.16%,特异度为58.62%,阳性预测值(positive predictive value,PPV)为58.14%,阴性预测值(negative predictive value,NPV)为96.23%。根治性膀胱切除术获得的病理结果与VI-RADS评分吻合度高达92.85%,显著高于行TURBT术的79.81%(P<0.05)。结论术前多参数磁共振VI-RADS评分具有良好的一致性和稳定性,与术后病理吻合度高;VI-RADS评分≥3分对肌层浸润性膀胱癌的预测价值较好,可指导临床手术选择方式。

Objective To evaluate the predictive value of vesical imaging-reporting and data system(VI-RADS)based on multi-parameter magnetic resonance imaging(MRI)for muscle invasive bladder cancer.Methods Clinical data of 278 patients undergoing transurethral resection of bladder tumor(TURBT)or radical cystectomy in our hospital from January 2017 to March 2021 were collected in this study.After VI-RADS score was assessed by 2 radiologists independently,Kappa test was used for the consistency of the obtained scores.Chi-square test was employed to analyze the consistency of VI-RADS score with pathological results.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of VI-RADS scores in the diagnosis of muscle invasive bladder cancer.The consistency of VI-RADS score with pathological Results of tissues obtained by different surgical Methods was analyzed with Chi-square test.Results The VI-RADS scores of the 2 radiologists were consistent with each other(coincidence rate:79.86%,kappa value:0.7508,P<0.001).ROC curve analysis showed that the area under curve(AUC),Yodon index,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)were 0.774,54.78%,96.16%,58.62%,58.14%and 96.23%,respectively,when predicting muscular invasion with VI-RADS score≥3 as the threshold.The study also found that the coincidence rate between the pathological Results of radical cystectomy and VI-RADS score was 92.85%,which was significantly higher than that of TURBT(79.81%,P<0.05).Conclusion VI-RADS score based on preoperative multi-parameter MRI has good consistency and stability,and is highly consistent with the Results of postoperative pathology.VI-RADS score≥3 has predictive diagnostic value for muscular-invasive bladder cancer and can guide the selection of clinical surgical methods.