膀胱癌磁共振影像报告结合VI-RADS系统双参数及多参数评分应用的研究

徐慧; 陈云天; 叶蕾; 郑涵瑜; 宋彬; 姚晋

doi:10.12182/20240960202

膀胱癌磁共振影像报告结合VI-RADS系统双参数及多参数评分应用的研究

Application of Magnetic Resonance Imaging Report Combined With VI-RADS Bi-Parametric and Multi-Parametric Scoring Systems in Bladder Cancer Diagnosis

摘要

摘要:
目的通过回顾性研究验证双参数膀胱影像报告体系（Vesical Imaging-Reporting and Data System, VI-RADS）评分系统〔T2加权（T2 weighted image, T2WI）和扩散加权（diffusion weighted image, DWI）〕与多参数VI-RADS评分系统〔T2WI、DWI与动态增强（dynamic contrast enhance, DCE）〕在膀胱癌患者磁共振诊断价值应用的研究。
方法调取2020年1月–2021年12月于我院泌尿外科因膀胱癌就诊且行膀胱磁共振检查的患者影像及临床资料，最终纳入膀胱癌患者215例，其中男性183例，女性32例，平均年龄（67.60±11.42）岁。所有病例均经过病理组织切片确诊膀胱癌。两位医师双盲对多序列单独评分，对比双参数与多参数评价系统对膀胱癌的诊断效能。使用受试者工作特征（receiver operator characteristic, ROC）曲线诊断试验及Cohen's Kappa分析进行诊断效能评价及一致性分析。
结果两位医师使用多参数VI-RADS评分系统在总体中曲线下面积（area under the curve, AUC）及其95%置信区间为0.878（0.830～0.925）和0.856（0.805～0.907）；双参数为0.889（0.844～0.934）和0.856（0.805～0.907），差异无统计学意义。在以TURBT亚组分析中差异也无统计学意义，两位医师的一致性评价Kappa值在多参数与双参数评价中分别为0.694与0.546（以VI-RADS≥3分为阳性）和0.693与0.712（以VI-RADS≥4分为阳性），且P均<0.001。
结论 VI-RADS双参数评分系统的诊断效能不劣于多参数评分系统，为对比剂过敏等无法进行增强检查的患者提供了选择。

Abstract:
Objective To verify by retrospective analysis the performance of applying dual-parametric (T2 weighted image T2WI and diffusion weighted image DWI) and multi-parametric (T2WI, DWI, and dynamic contrast enhance DCE) evaluation systems of Vesical Imaging-Reporting and Data System (VI-RADS) in the magnetic resonance imaging (MRI) diagnosis of bladder cancer.
Methods The imaging and clinical data of bladder cancer patients who underwent bladder MRI examination in the Department of Urology of our hospital between January 2020 and December 2021 were collected. A total of 215 bladder cancer patients, among whom there were 183 males and 32 females with an average age of (67.60±11.42) years, were included. The bladder cancer diagnosis of all the cases was verified by pathology analysis of tissue samples. Two radiologists, who were double-blinded, scored multiple sequences separately. Then, a comparative analysis was made on the diagnostic performance of dual-parametric and multi-parametric VI-RADS diagnostic scores. The diagnostic test with receiver operator characteristic (ROC) curves and Cohen's Kappa were used to evaluate the diagnostic efficacy and consistency.
Results The area under the curve (AUC) and 95% confidence interval (CI) of the multi-parametric VI-RADS evaluation system by the two radiologists in the overall population were 0.878 (0.830-0.925) and 0.856 (0.805-0.907), while those for the bi-parametric VI-RADS evaluation system were 0.889 (0.844-0.934) and 0.856 (0.805-0.907), showing no statistically significant difference. No significant difference was observed in the subgroup analysis of patients who underwent transurethral resection of bladder tumor (TURBT). Furthermore, the Kappa values for inter-rater agreement between of the two radiologists were 0.694 and 0.546 (with the VI-RADS score≥3 defined as being positive) and 0.693 and 0.712 (with the VI-RADS score≥4 defined as being positive) in multi-parametric and bi-parametric evaluation, respectively (all P<0.001).
Conclusion The bi-parametric VI-RADS scoring system can achieve a diagnostic efficacy comparable to that of the multi-parametric scoring system, offering an alternative to patients who are unable to undergo contrast-enhanced MRI due to allergic reaction to contrasts.

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