多模态MRI对膀胱尿路上皮癌临床分期及预后评估分析

Clinical staging and prognosis evaluation of bladder urothelial carcinoma by multimodal MRI

目的探讨多模态MRI对膀胱尿路上皮癌临床分期及预后评估分析。方法选择我院于2017年11月—2021年1月膀胱尿路上皮癌患者81例作为研究对象,均行多模态MRI和常规MRI检查。检查前所有患者禁食4~6 h,检查前60 min排尿后禁尿禁水至检查完成。采用1.5 T全身超导扫描仪行仰卧位膀胱MRI检查。以腹主动脉分叉至耻骨联合下缘为扫描范围。所有患者均于多模态MRI检查后1周内实施肿瘤切除术。结果多模态MRI对T3和T4期灵敏性和特异性高于常规MRI,差异均有统计学意义(P<0.05)。而多模态MRI与常规MRI对T1和T2期灵敏性和特异性比较差异无统计学意义(P>0.05)。TI期多模态MRI示膀胱左侧壁见结节状异常信号影,T1WI等信号,T2WI稍低信号,DWI呈高亮信号,ADC值局部稍减低,动态增强扫描后,病灶强化明显,病灶未累及肌层;治疗后1年复查未见明显复发,预后良好。T2期多模态MRI示膀胱右侧壁见结节状异常信号影,T1WI等信号,T2WI稍低信号,DWI呈高亮信号,ADC值减低,动态增强扫描后,病灶轻度强化,病灶基底部与肌层分界不清;治疗后2年复查未见明显复发,预后良好。T3期多模态MRI示膀胱左顶壁见团块状异常信号影,T1WI等信号,T2WI稍低信号,DWI呈高亮信号,ADC值减低,增强扫描后,病灶明显强化,肿块对应肌层结构显示中断,伴周围脂肪间隙浸润;治疗后2年复查未见明显复发,预后良好。T4期多模态MRI示膀胱右后壁见不规则团块状异常信号影,T1WI等信号,T2WI等信号,DWI呈高信号,ADC值减低,增强扫描后,病灶轻度持续性强化,肿块突破膀胱,累及子宫及直肠;预后好转。结论多模态MRI能对膀胱尿路上皮癌临床分期进行准确判断,且可较准确地评估患者预后。

Objective To investigate the clinical staging and prognosis evaluation of bladder urothelial carcinoma by multimodal MRI.Methods A total of 81 patients with bladder urothelial carcinoma from November 2017 to January 2021 in our hospital were selected as the research subjects,and all underwent multimodal MRI examination.All patients fasted for 4-6 hours before the examination,and urinated for 60 minutes before the examination until the completion of the examination.Supine bladder MRI was performed with a 1.5T whole-body superconducting scanner.The scanning range was from the bifurcation of the abdominal aorta lower border pubic symphysis.All patients underwent tumor resection within 1 week after multimodal MRI examination.Results The sensitivity and specificity of multimodal MRI for T3 and T4 were higher than conventional MRI,and the difference was statistically significant(P<0.05).There was no significant difference between multimodal MRI and conventional MRI in sensitivity and specificity of T1 and T2(P>0.05).Multimodal MRI in the TI stage showed nodular abnormal signal shadow on the left bladder wall,with equal signal on T1WI,slightly low signal on T2WI,high signal on DWI,and local ADC value decreased slightly.The muscle layer was not involved;no obvious recurrence was found in the follow-up one year after treatment,and the prognosis was good.T2-stage multimodal MRI showed nodular abnormal signal shadow on the right side of the bladder,with equal signal T1WI,slightly low signal T2WI,high signal DWI,decreased ADC value.The demarcation between the part and the muscle layer was unclear;no obvious recurrence was found in the re-examination two years after treatment,and the prognosis was good.Multimodal MRI in T3 stage showed that the left parietal wall of the bladder showed a mass abnormal signal shadow,with equal signal T1WI,slightly low signal T2WI,high signal on DWI,decreased ADC value.After enhanced scanning,the lesion was significantly enhanced,and the mass corresponds to the muscle layer.The structural display was interrupted,with infiltration of the surrounding fat space;no obvious recurrence was found in the re-examination two years after treatment,and the prognosis was good.Multimodal MRI in T4 stage showed irregular mass-like abnormal signal shadows in the right posterior wall of the bladder,isointensity on T1WI,isointensity on T2WI,hyperintensity on DWI,and decreased ADC value.After enhanced scanning,the lesions showed mild persistent enhancement and mass Breaks through the bladder,involving the uterus and rectum;prognosis improves.Conclusion Multimodal MRI can accurately judge the clinical staging of bladder urothelial carcinoma,more accurately evaluate the prognosis of patients.