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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (4): 701-704. doi: 10.19723/j.issn.1671-167X.2020.04.020

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3.0T磁共振成像在接受过经尿道膀胱肿瘤切除术膀胱癌中诊断肌层浸润的应用

赵世明1,杨铁军1,△(),许春苗2,郭孝峰1,马永康1,陈学军2,李祥3,何朝宏1   

  1. 1.郑州大学附属肿瘤医院,河南省肿瘤医院 泌尿外科, 郑州 450008
    2.郑州大学附属肿瘤医院,河南省肿瘤医院放射科, 郑州 450008
    3.郑州大学附属肿瘤医院,河南省肿瘤医院 医务科, 郑州 450008
  • 收稿日期:2020-04-06 出版日期:2020-08-18 发布日期:2020-08-06
  • 通讯作者: 杨铁军 E-mail:tiejunyang@126.com
  • 基金资助:
    河南省医学科技攻关计划省部共建项目(201601025);河南省科技厅科技攻关项目(182102310180)

Bladder cancer local staging about muscle invasion: 3.0T MRI performance following transurethral resection

Shi-ming ZHAO1,Tie-jun YANG1,△(),Chun-miao XU2,Xiao-feng GUO1,Yong-kang MA1,Xue-jun CHEN2,Xiang LI3,Chao-hong HE1   

  1. 1. Department of Urology, Affiliated Tumor Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
    2. Department of Radiology, Affiliated Tumor Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
    3. Medical Department, Affiliated Tumor Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
  • Received:2020-04-06 Online:2020-08-18 Published:2020-08-06
  • Contact: Tie-jun YANG E-mail:tiejunyang@126.com
  • Supported by:
    Henan Provincial Medical Science and Technology Research Project Jointly Established by the Ministry of Education(201601025);Science and Technology Key Project of Henan Provincial Science and Technology Department(182102310180)

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摘要：

目的: 评价3.0T 磁共振成像(magnetic resonance imaging, MRI)在接受过经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor, TURBT)膀胱癌中诊断肌层浸润情况的应用价值。方法: 选择2012年9月至2019年4月在郑州大学附属肿瘤医院收治的接受过TURBT两周后行3.0T MRI的膀胱癌患者病例资料进行回顾性分析,共收集到病例55例。由具有10年以上阅片经验的放射科医师协商诊断,通过MRI的T2加权像(T2 weighted imaging, T2WI)和/或扩散加权成像(diffusion-weighted imaging, DWI)判定膀胱癌是否存在肌层浸润,并与全膀胱切除术后的病理诊断相比较,评估3.0T MRI诊断膀胱癌肌层浸润情况(≥T2期)的敏感度、特异度和准确度。结果: 纳入的 55例患者,平均年龄60.76岁(42~82岁),男性48例,女性7例。MRI检查前均接受过TURBT(其中郑州大学附属肿瘤医院 16例,外院39例);所有患者MRI检查和TURBT间隔时间均大于2周,所有患者均在MRI检查后1个月内行根治性全膀胱切除术,且MRI检查后至根治性全膀胱切除期间未行放疗或化疗。术后病理诊断证实未见肿瘤残留2例;非肌层浸润性膀胱癌16例,其中13例分期为T1,3例分期为Ta期;肌层浸润性膀胱癌37例,其中19例分期为T2, 14例分期为T3, 4例分期为T4。放射诊断使用T2WI序列、DWI序列、T2WI+DWI序列诊断肌层浸润性膀胱癌的敏感度分别为94.59%、83.78%、91.89%,特异度分别为66.67%、77.78%、72.22%,准确度分别为85.45%、81.82%、85.45%。结论: T2WI序列拥有良好的软组织分辨率,有利于可疑病灶的发现及定位;DWI序列可以帮助医师区分膀胱癌和瘢痕纤维化;3.0T MRI T2WI+DWI序列在接受过TURBT的膀胱癌中对诊断肌层浸润情况拥有较高的准确度,具有一定的应用价值。

关键词: 磁共振成像, 膀胱肿瘤, TURBT

Abstract:

Objective: To evaluate the performance of 3.0T magnetic resonance imaging examination (MRI) for the local detecting of muscle invasive bladder cancer following transurethral resection of bladder tumor (TURBT). Methods: Retrospective study identified 55 patients with pathology-proven bladder cancer who underwent transurethral resection of bladder tumor followed by 3.0T magnetic resonance imaging between September 2012 and April 2019 in our hospital. Two radiologists reviewed pelvic magnetic resonance imaging together and judged muscle invasive bladder cancer. Sensitivity, specificity and accuracy were calculated for the presence of muscle invasion by T2 weighted imaging (T2WI) only, diffusion-weighted imaging (DWI) only and T2WI+DWI compared with the findings at radical cystectomy as the reference standard. Results: Of the 55 patients with pathological results from radical cystectomy, 3.64% (2/55) had no residual disease; 29.09% (16/55) were non-muscle invasive bladder cancer on pathology, including 13 cases in T1 and 3 cases in Ta; 34.55% (19/55) were in stage T2 depending on pathology, 25.45% (14/55) in T3, and 7.27% (4/55) in T4. The average age was 60.76 years, ranging from 42 to 82 years. There were 48 males and 7 females in our study. Before pelvic MRI examination, all the patients received transurethral resection of bladder tumor, including 16 cases taking the operation in our hospital and 39 cases in other hospitals. The interval between the pelvic MRI examination and transurethral resection of bladder tumor was more than 2 weeks in all the patients. They all underwent radical cystectomy within 1 month after the pelvic MRI examination, and no patient underwent radiotherapy or chemotherapy in our study during the interval between the MRI examination and radical cystectomy. T2WI only, DWI only, and T2WI+DWI of 3.0T magnetic resonance imaging for readers were with sensitivity: 94.59%, 83.78%, 91.89%; with specificity: 66.67%, 77.78%, 72.22% and with accuracy: 85.45%, 81.82%, 85.45%, respectively. Conclusion: 3.0T MRI may have a role in diagnosing muscle invasive bladder cancer following TURBT. T2WI has the advantage of detecting the location of bladder tumor, and DWI has the advantage of differentiating between the benign and malignant lesion. 3.0T MRI T2WI+DWI has a good utility in the detection of muscle invasive bladder cancer following TURBT with satisfied accuracy.

Key words: Magnetic resonance imaging, Urinary bladder Neoplasms, Neoplasm staging

中图分类号: 

  • R737.14

图1

3.0T MRI T2WI(A)和DWI(B)显示膀胱右后壁近膀胱三角区局限性增厚,T2WI呈低信号,DWI呈稍高信号,影像学诊断未见肿瘤病灶,术后全膀胱病理证实膀胱内未见癌残留"

图2

3.0T MRI中T2WI(A)和DWI(B)显示膀胱左侧壁不均匀增厚,T2WI呈条片状低信号,DWI高b值弥散受限呈高信号,膀胱肌层连续性中断,影像学提示膀胱癌存在肌层侵犯,术后全膀胱病理证实为肌层浸润性膀胱癌"

表1

3.0T MRI不同序列和组合在本组膀胱癌患者中诊断肌层侵犯情况"

Items T2WI DWI T2WI+DWI
Sensitivity 94.59 (35/37) 83.78 (31/37) 91.89 (34/37)
Specificity 66.67 (12/18) 77.78 (14/18) 72.22 (13/18)
Accuracy 85.45 (47/55) 81.82 (45/55) 85.45 (47/55)
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