多参数MRI对肌层浸润性膀胱癌的鉴别诊断价值

Value of multiparametric MRI to the differential diagnosis of invasive urinary bladder tumors

目的 应用多参数MRI(multiparametric MRI,mpMRI)对膀胱癌患者进行术前诊断,探讨其对肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的鉴别诊断价值。方法 40例膀胱癌患者均行根治性膀胱切除术,其中21例术前行新辅助治疗患者于治疗结束后3 d内,19例未行新辅助治疗患者于根治术前行mpMRI检查。以根治术后组织病理检查结果为金标准,评价mpMRI鉴别诊断非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)与MIBC及诊断T分期的效能。结果 40例患者中,mpMRI诊断为NMIBC者11例,MIBC者29例;根治术后组织病理检查结果诊断为NMIBC者13例,MIBC者27例;2例NMIBC患者mpMRI误诊为MIBC;以根治术后组织病理检查结果为金标准,mpMRI鉴别诊断NMIBC与MIBC的灵敏度为88.89%,特异度为61.54%,准确率为90.00%。mpMRI诊断T_(1)期11例,T_(2)期9例,T_(3)期18例,T_(4)期2例;根治术后组织病理检查诊断原位癌1例,T_(1)期13例,T_(2)期12例,T_(3)期10例,T_(4)期4例;mpMRI将1例原位癌诊断为T_(3)期,2例T_(1)期诊断为T_(2)期,5例T_(2)期诊断为T_(3)期,2例T_(3)期诊断为T_(4)期,4例T_(4)期诊断为T_(3)期;以根治术后组织病理检查结果为金标准,mpMRI诊断T分期的准确率为65.00%。结论 mpMRI鉴别诊断NMIBC与MIBC的灵敏度和准确率均较高,对膀胱癌T分期有一定诊断价值。

Objective To confirm the preoperative diagnosis of bladder cancer by using multiparametric MRI(mpMRI),and to investigate the differential diagnosis of muscle-invasive bladder cancer(MIBC).Methods In 40 patients with bladder cancer undergoing radical cystectomy,mpMRI was done in 21 patients receiving neoadjuvant therapy within 3 days after the accomplishment of neoadjuvant therapy,and in 19 patients receiving no neoadjuvant therapy before radical cystectomy.The efficiencies of mpMRI on the differential diagnosis of non-MIBC and MIBC as well as the diagnosis of T stage were evaluated by using the histopathological results after radical resection as the gold standard.Results In these 40 patients,mpMRI diagnosed 11 cases of non-MIBC and 29 cases of MIBC,and the postoperative histopathological results confirmed 13 cases of non-MIBC and 27 cases of MIBC.Two cases of non-MIBC were misdiagnosed as MIBC by mpMRI.Taking the postoperative histopathological results as the gold standard,the sensitivity,specificity and accuracy of mpMRI in the differential diagnosis of non-MIBC and MIBC were 88.89%,61.54% and 90.00%,respectively.mpMRI diagnosed 11 cases of T_(1) stage,9 of T_(2) stage,18 of T_(3) stage,and 2 of T_(4) stage.The postoperative histopathological results confirmed 1 case of carcinoma in situ,13 cases of T_(1) stage,12 of T_(2) stage,10 of T_(3) stage,and 4 of T_(4) stage.mpMRI misdiagnosed 1 case of carcinoma in situ as T_(3) stage,2 cases of T_(1) stage as T_(2) stage,5 cases of T_(2) stage as T_(3) stage,2 cases of T_(3) stage as T_(4) stage,and 4 cases of T_(4) stage as T_(3) stage.The overall accuracy of mpMRI in T staging was 65.00 %.Conclusion mpMRI has a high sensitivity and accuracy in the differential diagnosis of non-MIBC and MIBC,and it also has a certain value to the diagnosis of T stage of bladder cancer.