探究膀胱影像报告与数据系统在预测肌层浸润性膀胱癌中的应用

Exploration of Vesical Imaging-reporting and Data System Scoring System in Predicting Muscle Invasion of Bladder Cancer

目的本研究旨在探讨多参数MRI膀胱影像报告与数据系统(vesical imaging reporting and data system,VI-RADS)预测肌层浸润性膀胱癌的准确性。方法本研究涵盖了113名经过特殊膀胱磁共振成像(mpMRI)检测的病例。在评估过程中,由两位资深的放射学专家遵循VI-RADS系统的指导方针,独立完成了对影像资料的评分工作。通过t检验和卡方检验初步比较临床病理数据,再用多因素logistic回归模型来确定与肌层浸润性膀胱癌相关预测因素。本研究通过受试者工作特征(receiver operating characteristic,ROC)曲线的分析方法,评估了VI-RADS评分系统在识别膀胱癌是否侵犯肌层方面的准确性。研究中计算了ROC曲线下的面积(area under the curve,AUC),以此来衡量诊断模型的整体性能。此外,根据不同的评分界限,我们进一步分析了诊断的敏感性(sensitivity)、特异性(specificity)、以及预测膀胱癌肌层浸润的阳性(positive predictive value,PPV)和阴性(negative predictive value,NPV)预测值。结果本研究共纳入113例患者,男91例,女22例。多变量logistic回归模型分析结果显示只有高的VI-RADS评分与肌层浸润性膀胱癌有关(优势比为8.56;P<0.001)。VIRADS评分ROC曲线下面积为0.91。VI-RADS评分根据不同的阈值来定义肌层浸润性膀胱癌。当把VI-RADS≥3设置为阈值时,敏感度、特异度、阳性预测值(positive predictive Value,PPV)、阴性预测值(negative predictive value,NPV)分别为90%、78%、60%、96%。MIBC的分界点移至VIRADS≥4,则敏感度、特异度、PPV、NPV分别为90%、82%、64%、96%。结论VI-RADS评分能够较准确地预测肌层浸润性膀胱癌,是一种有效的、有前途的术前预测肌层浸润性膀胱癌的方法。

Objective To explore the accuracy of using the Vesical Imaging-Reporting and Data System(VI-RADS)scoring system in predicting muscle invasive of bladder cancer(MIBC).Methods This study included 113 cases that underwent special bladder magnetic resonance imaging(mpMRI).During the evaluation process,two senior radiologists followed the guidelines of the VI-RADS system and independently completed the scoring of the imaging data.Clinicopathologic data were initially compared by t-test and Chi-square test,and then multivariate logistic regression modeling was used to determine factors associated with muscle invasive of bladder cancer.This study evaluated the accuracy of the VI-RADS scoring system in identifying whether bladder cancer invades the muscle layer by analyzing the receiver operating characteristic(ROC)curve.The area under the ROC curve(AUC)was calculated to measure the overall performance of the diagnostic model.In addition,according to different scoring cutoffs,we further analyzed the sensitivity,specificity,and positive predictive value(PPV)and negative predictive value(NPV)of the diagnosis for predicting muscle layer invasion of bladder cancer.Results A total of 113 patients,91 males and 22 females were included in this study.Multivariate logistic regression model analysis showed that only the higher VI-RADS score was associated with MIBC(odds ratio,8.56;P<0.001).the area under ROC curve was 0.91.the VI-RADS score was based on the different threshold to define MIBC.when VI-RADS≥3 is set as the threshold,the sensitivity,specificity,PPV,and The NPV are 90%,78%,60%,and 96%,respectively.the cutoff point for MIBC is shifted to VI-RADS≥4,the sensitivity,specificity,PPV,and NPV were 90%,82%,64%,and 96%,respectively.Conclusion VIRADS score can accurately predict muscle invasive bladder cancer,which is an effective and promising method for preoperative prediction of muscle invasive bladder cancer.