许春苗,黎海亮,张孝先,郑冰洁,夏威利,袁军辉,姚琦,陈学军.逐层匀场技术弥散加权成像评价膀胱癌[J].中国医学影像技术,2021,37(7):1054~1058
逐层匀场技术弥散加权成像评价膀胱癌
Diffusion-weighted imaging with integrated slice-by-slice shimming for evaluation of bladder cancer
投稿时间:2020-07-22  修订日期:2021-05-17
DOI:10.13929/j.issn.1003-3289.2021.07.021
中文关键词:  膀胱肿瘤  诊断  弥散磁共振成像
英文关键词:urinary bladder neoplasms  diagnosis  diffusion magnetic resonance imaging
基金项目:河南省科技发展计划(182102310180)。
作者单位E-mail
许春苗 河南省肿瘤医院放射科, 河南 郑州 450008  
黎海亮 河南省肿瘤医院放射科, 河南 郑州 450008  
张孝先 河南省肿瘤医院放射科, 河南 郑州 450008  
郑冰洁 河南省肿瘤医院放射科, 河南 郑州 450008  
夏威利 河南省肿瘤医院放射科, 河南 郑州 450008  
袁军辉 河南省肿瘤医院放射科, 河南 郑州 450008  
姚琦 河南省肿瘤医院放射科, 河南 郑州 450008  
陈学军 河南省肿瘤医院放射科, 河南 郑州 450008 chenxuejun1967@163.com 
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中文摘要:
      目的 对比基于逐层匀场技术弥散加权成像(iShim-DWI)与常规弥散加权成像(DWI)图像质量,评估iShim-DWI对膀胱癌的应用价值。方法 回顾性分析70例经手术病理证实的膀胱癌患者,依据TNM分期将其分为肌层浸润性膀胱癌(MIBC)组(n=34)和非肌层浸润性膀胱癌(NMIBC)组(n=36),根据术后病理分级分为低级别尿路上皮癌组(n=38)和高级别尿路上皮癌组(n=32)。观察常规DWI和iShim-DWI图像质量的差异。测量iShim-DWI病灶表观弥散系数(ADC),比较NMIBC组与MIBC组、高、低级别尿路上皮癌组ADC差异。以受试者工作特征(ROC)曲线评估ADC鉴别膀胱癌肌层浸润及高、低级别膀胱癌和T2WI、传统DWI及iShim-DWI诊断膀胱癌肌层浸润的效能。结果 2名医师对iShim-DWI图像的主观评分均高于传统DWI(P均<0.01)。NMIBC组ADC[1.12(1.06,1.18)×10-3 mm2/s]大于MIBC组[0.81(0.75,0.83)×10-3 mm2/s,Z=-6.79,P<0.01],ADC鉴别MIBC与NMIBC的AUC为0.97;低级别尿路上皮癌组ADC[1.13(1.06,1.17)×10-3 mm2/s]大于高级别尿路上皮癌组[0.80(0.74,0.82)×10-3 mm2/s,Z=-6.79,P<0.01],AUC为0.99。基于T2WI+常规DWI诊断膀胱癌肌层浸润的AUC均低于T2WI+iShim-DWI(P均<0.05)。结论 iShim-DWI有助于评估膀胱癌病理分级及肌层浸润,且图像质量优于常规DWI。
英文摘要:
      Objective To compare the image quality of diffusion-weighted imaging based on integrated slice-by-slice shimming technique (iShim-DWI) and conventional diffusion-weighted imaging (DWI), and to evaluate the value of iShim-DWI for bladder cancer. Methods Data of 70 patients with post-surgery pathology confirmed bladder cancer were retrospectively analyzed. The patients were divided into muscular invasive bladder cancer (MIBC) group (n=34) and non-muscular invasive bladder cancer (NMIBC) group (n=36) as well as low-grade urothelial carcinoma group (n=38) and high-grade urothelial carcinoma group (n=32) according to TNM stages and post operation pathological findings, respectively. The image quality of conventional DWI and iShim-DWI were scored and compared. The apparent diffusion coefficients (ADC) were measured on iShim-DWI, and ADC were compared between NMIBC group and MIBC group, also between high and low grade urothelial carcinoma group. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of ADC for differentiating muscular invasions and grades of bladder cancer, and the diagnostic efficacy of muscular invasion of bladder cancer was compared between T2WI + traditional DWI and T2WI + iShim-DWI, then the corresponding areas under the curves (AUC) were calculated. Results The subjective scores of iShim-DWI were higher than those of traditional DWI images (both P<0.01). ADC of NMIBC group (1.12 [1.06, 1.18]×10-3 mm2/s) was higher than that of MIBC group (0.81[0.75, 0.83]×10-3 mm2/s, Z=-6.79, P<0.01), and AUC of ADC for differentiating MIBC and NMIBC was 0.97. ADC of low-grade urothelial carcinoma group (1.13 [1.06, 1.17]×10-3 mm2/s) was higher than that of high-grade urothelial carcinoma group (0.80 [0.74, 0.82]×10-3 mm2/s, Z=-6.79, P<0.01), and AUC of ADC in judging low and high-grade urothelial carcinoma was 0.99. AUC of assessing muscular invasion of bladder cancer based on T2WI + conventional DWI was lower than that of T2WI + iShim-DWI (both P<0.05). Conclusion IShim-DWI was helpful to evaluation of pathological grade and muscular infiltration of bladder cancer with image quality better than traditional DWI.
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