目的：探讨多参数磁共振成像（mp-MRI）膀胱影像报告和数据系统（VI-RADS）的评分一致性及其在膀胱癌肌层浸润中的诊断价值。方法：回顾性分析经手术病理证实的99例（共109个癌灶）膀胱癌患者的资料。根据肿瘤是否侵犯固有肌层分为非肌层浸润性膀胱癌（NMIBC，≤T1期）和肌层浸润性膀胱癌（MIBC，≥T2期）两组。由两位阅片者独立盲法对病灶mp-MRI图像进行VI-RADS评分。采用Kappa检验分析两位阅片者VI-RADS评分的一致性。绘制受试者工作特征曲线（ROC）分析VI-RADS评分诊断膀胱癌肌层浸润的效能。结果：两位阅片者VI-RADS评分一致性良好（Kappa值=0.721，P<0.001）。根据ROC曲线分析，以VI-RADS≥4分为阈值，两位阅片者的诊断曲线下面积（AUC）分别为0.912和0.925，敏感性为76.2%和71.4%，特异性为95.5%和95.5%，阳性预测值为80.0%和79.0%，阴性预测值为94.4%和93.3%。结论：VI-RADS评分具有良好的一致性和稳定性。mp-MRI VI-RADS评分对膀胱癌肌层浸润的诊断具有重要的价值，有较高的特异性和阴性预测值。
Abstract
Objective: To investigate interobserver agreement and diagnosis value of multiparametric MRI(mp-MRI) using vesical imaging-reporting and data system(VI-RADS) in detecting muscle-invasiveness of bladder cancer. Methods: Retrospective analysis of 99 patients(109 tumors in total) with pathologically confirmed bladder cancer was made in this study. The tumors was classified as non-muscle invasive bladder cancer(NMIBC) with stage T1 or lower and muscle invasive bladder cancer(MIBC) with stage T2 or higher. The mp-MRI images of tumors were scored by two radiologists independently with blind method by using VI-RADS. Interobserver agreement was evaluated by using Kappa test. Receivers operating characteristic(ROC) curves were used to describe the diagnostic efficiency of two radiologists. Results: Interobserver agreement of VI-RADS was good(Kappa value=0.721, P<0.001). According to ROC analysis, VI-RADS score 4 was found to be the best cut-off levels for discriminating NMIBC from MIBC by two radiologists, with the AUC of 0.912 and 0.925, the sensitivity of 76.2% and 71.4%, the specificity of 95.5% and 95.5%, the positive predictive value of 80.0% and 79.0%, the negative predictive value of 94.4% and 93.3%, respectively． Conclusion: The VI-RADS shows good consistency and stability for evaluation bladder cancer. Futhermore, VI-RADS demonstrates a good accuracy in the detection of muscle-invasiveness of bladder cancer, and provides a high specificity and negative predictive value.
关键词
膀胱肿瘤 /
磁共振成像
Key words
Bladder neoplasms /
Magnetic resonance imaging
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