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目的:探讨磁共振(magnetic resonance,MR)扩散加权成像(diffusion-weighted imaging,DWI)及表观扩散系数(apparent diffusion coefficient,ADC)值在膀胱肿瘤诊断、分期及分级中的应用价值。方法:2010年1月—2011年2月,共收集73例膀胱占位患者的DWI图像,并结合术后病理诊断结果分析DWI诊断膀胱癌的敏感度及特异度;分别测量膀胱癌、肿瘤周围膀胱壁、尿液及膀胱炎症的ADC值并进行比较。对膀胱癌患者DWI图像进行肿瘤分期,与常规MR及病理结果对照,对不同分级膀胱尿路上皮癌的ADC值进行比较。结果:DWI诊断膀胱癌的敏感度、特异度和准确度分别为92.3%、75.0%和90.4%。膀胱癌、膀胱炎症、病灶周围膀胱壁和尿液的平均ADC值分别为(0.97±0.25)×10-3mm2/s、(1.49±0.15)×10-3mm2/s、(1.47±0.13)×10-3mm2/s和(2.57±0.17)×10-3mm2/s,膀胱癌与病灶周围膀胱壁、膀胱癌与尿液、膀胱癌与膀胱炎症的平均ADC值之间差异均有统计学意义(P<0.01)。DWI区分非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)和肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)的敏感度、特异度和准确度分别为93.2%、68.8%和86.7%,与常规MR的77.3%、50.0%和70.0%比较,两者之间差异有统计学意义(P=0.027)。高分级与低分级膀胱尿路上皮癌的平均ADC值分别为(0.78±0.13)×10-3mm2/s和(1.14±0.21)×10-3mm2/s,两者之间差异有明显的统计学意义(P<0.01)。通过受试者工作特性(receiver operating characteristic,ROC)曲线,ADC值≤1.04×10-3mm2/s为阈值时,区分高分级与低分级膀胱尿路上皮癌的敏感度和特异度分别为84.8%和91.7%。结论:DWI及ADC值用于膀胱癌的诊断有较好的效果,同时DWI对膀胱癌肿瘤分期有较高的准确度,ADC值能够量化区分不同分级膀胱尿路上皮癌。
Objective: To investigate the value of magnetic resonance (MR) diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) in the diagnosis, staging and grading of bladder tumors. Methods: From January 2010 to February 2011, a total of 73 DWI images of bladder cancer patients were collected, and the sensitivity and specificity of DWI in diagnosis of bladder cancer were analyzed with postoperative pathological diagnosis. The bladder cancer, Bladder wall, urine and bladder inflammation ADC values and compared. DWI images of patients with bladder cancer were staged, compared with the conventional MR and pathological results, the ADC value of different grades of bladder urothelial carcinoma were compared. Results: The sensitivity, specificity and accuracy of DWI in the diagnosis of bladder cancer were 92.3%, 75.0% and 90.4% respectively. The average ADC values of bladder cancer, cystitis, bladder wall and urine around the lesion were (0.97 ± 0.25) × 10-3mm2 / s, (1.49 ± 0.15) × 10-3mm2 / s and (1.47 ± 0.13) × 10 (2.57 ± 0.17) × 10-3mm2 / s, the average ADC value of bladder cancer and the bladder wall around the lesion, bladder cancer and urine, bladder cancer and bladder inflammation were statistically significant (P <0.01). The sensitivity, specificity and accuracy of DWI in distinguishing non-muscle invasive bladder cancer (MMI) from muscle-invasive bladder cancer (MIBC) were 93.2% and 68.8% And 86.7% respectively. There was a significant difference between the two groups (P = 0.027) when compared with the conventional MR of 77.3%, 50.0% and 70.0%. The average ADC values of high-grade and low-grade bladder urothelial carcinoma were (0.78 ± 0.13) × 10-3mm2 / s and (1.14 ± 0.21) × 10-3mm2 / s, respectively Significance (P <0.01). Sensitivity and specificity of distinguishing high-grade and low-grade bladder urothelial carcinoma were 84.8% when the receiver operating characteristic (ROC) curves were used and the ADC value was ≤1.04 × 10-3mm2 / s as the threshold value. And 91.7%. Conclusion: DWI and ADC values are useful for the diagnosis of bladder cancer. DWI has a higher accuracy for staging of bladder cancer, and ADC value can quantify the different grades of bladder cancer.