Nonmuscle-invasive and Muscle-invasive Urinary Bladder Cancer: Image Quality and Clinical Value of Reduced Field-of-view Versus Conventional Single-shot Echo-planar Imaging DWI.
Nonmuscle-invasive and Muscle-invasive Urinary Bladder Cancer: Image Quality and Clinical Value of Reduced Field-of-view Versus Conventional Single-shot Echo-planar Imaging DWI.
复制标题
非肌层浸润性和肌层浸润性膀胱癌缩小视野与传统单次回波平面成像 DWI 的图像质量和临床价值
DOI：
10.1097/md.0000000000002951
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发表时间：
2016-03
期刊：
影响因子：
1.6
通讯作者：
Hu D
中科院分区：
文献类型：
--
作者：
Wang Y;Li Z;Meng X;Hu X;Shen Y;Morelli J;Lin H;Zhang Z;Hu D
本研究比较了非肌肉浸润性或肌肉浸润性膀胱癌患者的缩小视野（rFOV）弥散加权成像（DWI）和全视野（fFOV）单次激发平面回波成像的成像质量、诊断准确性和表观弥散系数（ADC）值。在这项内部审查委员会批准的研究中，39例患者（60个膀胱肿瘤）接受了rFOV和fFOV DWI。所有肿瘤的病理学和组织学分级。两名观察员使用4分量表评定DWI图像质量。两名对病理学结果不知情的放射科医生审查了3个图像集（单独T2加权、T2加权加fFOV DWI和T2加权加rFOV DWI），并为T2或更高分期的肿瘤分配了T分期和置信水平。使用Wilcoxon符号秩检验评估2个DWI序列的图像质量评分。使用McNemar检验评价每个图像集的诊断准确性、灵敏度和特异性差异。通过比较受试者工作特征曲线下面积（即Az值）分析性能差异。使用Mann-Whitney U检验比较平均ADC以及肿瘤分期和组织学分级之间的关系。rFOV的图像质量评分（平均值= 3.62）显著高于fFOV DWI（2.98; P <0.001）。 单独T2加权图像、T2加权加fFOV DWI图像和T2加权加rFOV DWI图像的合并诊断准确性分别为57%、70%和78%。增加rFOV DWI后T2及以上分期的总体准确性、特异性和Az均显著提高（P <0.05）。 肌层浸润性膀胱癌和G3级膀胱癌的ADC值均显著低于非肌层浸润性膀胱癌和G1级膀胱癌（P <0.01）。 在图像质量和诊断准确性方面，rFOV DWI上级优于fFOV DWI。ADC值可能有助于区分非肌层浸润性和肌层浸润性癌，以及G1和G3级病变。
This study compared the imaging quality, diagnostic accuracy, and apparent diffusion coefficient (ADC) values of reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) and full field-of-view (fFOV) single-shot echo-planar imaging with regard to patients with nonmuscle-invasive or muscle-invasive bladder cancer. Thirty-nine patients with 60 bladder tumors underwent rFOV and fFOV DWI in this internal review board-approved study. Pathologic and histologic grades were determined for all tumors. Two observers rated DWI image quality using a 4-point scale. Two radiologists who were blinded to the pathology findings reviewed 3 image sets (T2-weighted alone, T2-weighted plus fFOV DWI, and T2-weighted plus rFOV DWI) and assigned T stages and confidence levels for tumors of stage T2 or higher. The image quality scores for the 2 DWI sequences were assessed using the Wilcoxon signed-rank test. Differences in the diagnostic accuracy, sensitivity, and specificity for each image set were evaluated using the McNemar test. Differences in performance were analyzed by comparing the areas under the receiver-operating characteristic curves (ie, the Az values). A Mann–Whitney U test was used to compare the mean ADCs and the relationship between tumor stage and histologic grade. Image quality scores were significantly higher for rFOV (mean = 3.62) than for fFOV DWI (2.98; P < 0.001). The pooled diagnostic accuracies were 57%, 70%, and 78% for the T2-weighted alone images, the T2-weighted plus fFOV DWI images, and the T2-weighted plus rFOV DWI images, respectively. The overall accuracy, specificity, and Az for diagnosing T2 or higher stages were significantly improved by adding rFOV DWI (P < 0.05). The mean ADC values of the muscle-invasive and G3 grade bladder cancers were significantly lower than those of the nonmuscle-invasive tumors and G1 grade cancers, regardless of DWI sequence (P < 0.01). rFOV DWI is superior to fFOV DWI with respect to image quality and diagnostic accuracy. ADC values might be useful for distinguishing nonmuscle-invasive from muscle-invasive cancers, and G1 from G3 grade lesions.