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Prince MR, Shaish H. Editorial for "Detecting Muscle Invasion of Bladder Cancer: An Application of Diffusion Kurtosis Imaging Ratio and Vesical Imaging-Reporting and Data System". J Magn Reson Imaging 2024; 60:65-66. [PMID: 37840196 DOI: 10.1002/jmri.29054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York City, New York, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Irving Medical Center, New York City, New York, USA
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Qin C, Tian Q, Zhou H, Qin Y, Zhou S, Wu Y, Tianjiao E, Duan S, Li Y, Wang X, Chen Z, Zheng G, Feng F. Detecting Muscle Invasion of Bladder Cancer: An Application of Diffusion Kurtosis Imaging Ratio and Vesical Imaging-Reporting and Data System. J Magn Reson Imaging 2024; 60:54-64. [PMID: 37916908 DOI: 10.1002/jmri.29053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Independent factors are needed to supplement vesical imaging-reporting and data system (VI-RADS) to improve its ability to identify muscle invasive bladder cancer (MIBC). PURPOSE To assess the correlation between MIBC and diffusion kurtosis imaging (DKI) ratio, VI-RADS, and other factors (such as tumor location). STUDY TYPE Retrospective. POPULATION Sixty-eight patients (50 males and 18 females; age: 70.1 ± 9.5 years) with bladder urothelial carcinoma. FIELD STRENGTH/SEQUENCE 1.5 T, conventional diffusion-weighted imaging (DWI), and DKI (single shot echo-planar sequence). ASSESSMENT Three radiologists independently measured the diffusion parameters of each bladder cancer (BCa) and obturator internus, including the mean apparent diffusion coefficient (ADCmean), mean kurtosis (MK), and mean diffusion (MD). And the ratio of diffusion parameters between BCa and obturator internus was calculated (diffusion parameter ratio = bladder cancer:obturator internus). Based on the VI-RADS, the target lesions were independently scored. Furthermore, the actual tumor-wall contact length (ACTCL) and absolute tumor-wall contact length (ABTCL) were measured. STATISTICAL TESTS Multicollinearity among independent variables was evaluated using the variance inflation factor (VIF). Multivariable logistic regression analysis was used to determine the independent risk factors of MIBC. The receiver operating characteristic curve was used to evaluate the efficacy of each variable in detecting MIBC. The DeLong test was used to compare the area under the curve (AUC). A P < 0.05 was considered statistically significant. RESULTS MKratio (median: 0.62) and VI-RADS were independent risk factors for MIBC. AUCs for MKratio, VI-RADS, and MKratio combined with VI-RADS in assessing MIBC were 0.895, 0.871, and 0.973, respectively. MKratio combined with VI-RADS was more effective in diagnosing MIBC than VI-RADS alone. DATA CONCLUSIONS MKratio has potential to assist the assessment of MIBC. MKratio can be used as a supplement to VI-RADS for detecting MIBC. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Cai Qin
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Qi Tian
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Hui Zhou
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Yihan Qin
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Siyu Zhou
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Yutao Wu
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Tianjiao E
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Shufeng Duan
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Yueyue Li
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Xiaolin Wang
- Department of Urology Surgery, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Zhigang Chen
- Department of Urology Surgery, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Guihua Zheng
- Department of Pathology, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, China
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Liu WJ, Campbell RA, Michael PD, Wood A, Haywood SC, Eltemamy M, Kaouk J, Campbell SC, Haber GP, Weight CJ, Remer EM, Almassi N. Clinical upstaging after neoadjuvant chemotherapy impacting eligibility for vaginal-sparing cystectomy: identifying bladder cancer patients who may benefit from interim imaging. Urology 2024:S0090-4295(24)00474-6. [PMID: 38908561 DOI: 10.1016/j.urology.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION AND OBJECTIVES Limited data exists on the frequency with which clinical progression during neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (MIBC) impacts eligibility for a vaginal-sparing surgical approach or on the utility of interim imaging assessment. We sought to evaluate the incidence of clinical upstaging following NAC that would render a patient ineligible for a vaginal-sparing cystectomy. METHODS 89 female patients with non-metastatic MIBC treated with NAC and radical cystectomy (RC) (2012-2023) were retrospectively reviewed. Tumor location(s) was determined from transurethral resection of bladder tumor operative reports. Pre- and post-NAC clinical staging was determined from imaging. Outcomes of interest included clinical upstaging and upstaging to vaginal invasion after NAC. RESULTS 75/89 patients had pre- and post-NAC imaging. 55 had no change in clinical staging, six patients were upstaged (4 cT2→cT3, 2 cT3→cT4), and 14 patients were downstaged (13 cT3→cT2, 1 cT4→cT2). Of the 75 patients with pre- and post-NAC imaging, 39 had trigone tumors. Of these, 28 had no change in clinical staging, two were upstaged (1 cT2→cT3, 1 cT3→cT4) and nine were downstaged (8 cT3→cT2, 1 cT4→cT2). Overall, 6/75 (8%) of patients demonstrated clinical upstaging after NAC. 2/39 (5%) of patients with trigone tumors clinically progressed after NAC and both had vaginal invasion (pT4) on final pathology. CONCLUSIONS Although clinical upstaging after NAC was infrequent, 5% of patients with trigonal MIBC were rendered ineligible for vaginal-sparing cystectomy following NAC due to progression. Interim imaging assessment may identify non-responders and preserve eligibility for vaginal-sparing RC.
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Affiliation(s)
- William J Liu
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Patrick D Michael
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Andrew Wood
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Samuel C Haywood
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Mohamed Eltemamy
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Steven C Campbell
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Erick M Remer
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Radiology, Diagnostic Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Takeuchi M, Tamada T, Higaki A, Kojima Y, Ueno Y, Yamamoto A. Pictorial review of the diagnosis of muscle-invasive bladder cancer using vesical imaging-reporting and data system (VI-RADS). Abdom Radiol (NY) 2024:10.1007/s00261-024-04424-3. [PMID: 38900320 DOI: 10.1007/s00261-024-04424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
The Vesical Imaging-Reporting and Data System (VI-RADS) is a standard magnetic resonance imaging (MRI) and diagnostic method for muscle-invasive bladder cancer that was published in 2018. Several studies have demonstrated that VI-RADS has high diagnostic power and reproducibility. However, reading VI-RADS requires a certain amount of expertise, and radiologists need to be aware of the various pitfalls. MRI of the bladder includes T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCEI). T2WI is excellent for understanding anatomy. DWI and DCEI show high contrast between the tumor and normal anatomical structures and are suitable for staging local tumors. Bladder tumors are classified into five categories according to their size and morphology and their positional relationship to the bladder wall based on the VI-RADS diagnostic criteria. If the T2WI, DWI, and DCEI categories are the same, the category is the VI-RADS category. If the categories do not match, the DWI category is the VI-RADS category. If image quality of DWI is not evaluable, the DCEI category is the final category. In many cases, DWI is dominant, but this does not mean that T2WI and DCEI can be omitted from the reading of the bladder. In this educational review, typical and atypical teaching cases are demonstrated, and how to resolve misdiagnosis and the limitations of VI-RADS are discussed. The most important aspect of VI-RADS reading is to practice multiparametric reading with a solid understanding of the characteristics and role of each sequence and an awareness of the various pitfalls.
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Affiliation(s)
- Mitsuru Takeuchi
- Department of Radiology, Radiolonet Tokai, 3-86-2, Asaoka-Cho, Chikusa-Ku, Nagoya, Aichi, 464-0811, Japan.
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan.
| | - Tsutomu Tamada
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Atsushi Higaki
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Yuichi Kojima
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Akira Yamamoto
- Kawasaki Medical School, Department of Radiology, 577 Matsushima, Kurasiki, Okayama, 701-0192, Japan
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Li S, Fan Z, Guo J, Li D, Chen Z, Zhang X, Wang Y, Li Y, Yang G, Wang X. Compressed sensing 3D T2WI radiomics model: improving diagnostic performance in muscle invasion of bladder cancer. BMC Med Imaging 2024; 24:148. [PMID: 38886638 PMCID: PMC11181529 DOI: 10.1186/s12880-024-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Preoperative discrimination between non-muscle-invasive bladder cancer (NMIBC) and the muscle invasive bladder cancer (MIBC) is a determinant of management. The purpose of this research is to employ radiomics to evaluate the diagnostic value in determining muscle invasiveness of compressed sensing (CS) accelerated 3D T2-weighted-SPACE sequence with high resolution and short acquisition time. METHODS This prospective study involved 108 participants who underwent preoperative 3D-CS-T2-weighted-SPACE, 3D-T2-weighted-SPACE and T2-weighted sequences. The cohort was divided into training and validation cohorts in a 7:3 ratio. In the training cohort, a Rad-score was constructed based on radiomic features selected by intraclass correlation coefficients, pearson correlation coefficient and least absolute shrinkage and selection operator . Multivariate logistic regression was used to develop a nomogram combined radiomics and clinical indices. In the validation cohort, the performances of the models were evaluated by ROC, calibration, and decision curves. RESULTS In the validation cohort, the area under ROC curve of 3D-CS-T2-weighted-SPACE, 3D-T2-weighted-SPACE and T2-weighted models were 0.87(95% confidence interval (CI):0.73-1.00), 0.79(95%CI:0.63-0.96) and 0.77(95%CI:0.60-0.93), respectively. The differences in signal-to-noise ratio and contrast-to-noise ratio between 3D-CS-T2-weighted-SPACE and 3D-T2-weighted-SPACE sequences were not statistically significant(p > 0.05). While the clinical model composed of three clinical indices was 0.74(95%CI:0.55-0.94) and the radiomics-clinical nomogram model was 0.88(95%CI:0.75-1.00). The calibration curves confirmed high goodness of fit, and the decision curve also showed that the radiomics model and combined nomogram model yielded higher net benefits than the clinical model. CONCLUSION The radiomics model based on compressed sensing 3D T2WI sequence, which was acquired within a shorter acquisition time, showed superior diagnostic efficacy in muscle invasion of bladder cancer. Additionally, the nomogram model could enhance the diagnostic performance.
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Affiliation(s)
- Shuo Li
- Department of Radiology, The First Hospital of Shanxi Medical University, No.85 Jiefang South Road, Taiyuan, 030001, Shanxi Province, P.R. China
| | - Zhichang Fan
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, Shanxi, P.R. China
| | - Junting Guo
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, Shanxi, P.R. China
| | - Ding Li
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, Shanxi, P.R. China
| | - Zeke Chen
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, Shanxi, P.R. China
| | - Xiaoyue Zhang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, Shanxi, P.R. China
| | - Yongfang Wang
- Department of Radiology, The First Hospital of Shanxi Medical University, No.85 Jiefang South Road, Taiyuan, 030001, Shanxi Province, P.R. China
| | - Yan Li
- Department of Radiology, The First Hospital of Shanxi Medical University, No.85 Jiefang South Road, Taiyuan, 030001, Shanxi Province, P.R. China
| | - Guoqiang Yang
- Department of Radiology, The First Hospital of Shanxi Medical University, No.85 Jiefang South Road, Taiyuan, 030001, Shanxi Province, P.R. China
| | - Xiaochun Wang
- Department of Radiology, The First Hospital of Shanxi Medical University, No.85 Jiefang South Road, Taiyuan, 030001, Shanxi Province, P.R. China.
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Kong L, Ling J, Cao W, Wen Z, Lin Y, Cai Q, Chen Y, Guo Y, Chen J, Wang H. Multiparametric MR characterization for human epithelial growth factor receptor 2 expression in bladder cancer: an exploratory study. Abdom Radiol (NY) 2024:10.1007/s00261-024-04378-6. [PMID: 38867120 DOI: 10.1007/s00261-024-04378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To investigate the application value of multiparametric MRI in evaluating the expression status of human epithelial growth factor receptor 2 (HER2) in bladder cancer (BCa). METHODS From April 2021 to July 2023, preoperative imaging manifestations of 90 patients with pathologically confirmed BCa were retrospectively collected and analyzed. All patients underwent multiparametric MRI including synthetic MRI, DWI, from which the T1, T2, proton density (PD) and apparent diffusion coefficient (ADC) values were obtained. The clinical and imaging characteristics as well as quantitative parameters (T1, T2, PD and ADC values) between HER2-positive and -negative BCa were compared using student t test and chi-square test. The diagnostic efficacy of parameters in predicting HER2 expression status was evaluated by calculating the area under ROC curve (AUC). RESULTS In total, 76 patients (mean age, 63.59 years ± 12.84 [SD]; 55 men) were included: 51 with HER2-negative and 25 with HER2-positive BCa. HER2-positive group demonstrated significantly higher ADC, T1, and T2 values than HER2-negative group (all P < 0.05). The combination of ADC values and tumor grade yielded the best diagnostic performance in evaluating HER2 expression level with an AUC of 0.864. CONCLUSION The multiparametric MR characterization can accurately evaluate the HER2 expression status in BCa, which may further guide the determination of individualized anti-HER2 targeted therapy strategies.
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Affiliation(s)
- Lingmin Kong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Jian Ling
- Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Wenxin Cao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Zhihua Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Yingyu Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Qian Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China.
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China.
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Zhang X, Xu X, Wang Y, Zhang J, Hu M, Zhang J, Zhang L, Wang S, Li Y, Zhao X, Chen Y. Reduced field-of-view DWI based on deep learning reconstruction improving diagnostic accuracy of VI-RADS for evaluating muscle invasion. Insights Imaging 2024; 15:139. [PMID: 38853219 PMCID: PMC11162985 DOI: 10.1186/s13244-024-01686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/02/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVES To investigate whether reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) with deep learning reconstruction (DLR) can improve the accuracy of evaluating muscle invasion using VI-RADS. METHODS Eighty-six bladder cancer participants who were evaluated by conventional full field-of-view (fFOV) DWI, standard rFOV (rFOVSTA) DWI, and fast rFOV with DLR (rFOVDLR) DWI were included in this prospective study. Tumors were categorized according to the vesical imaging reporting and data system (VI-RADS). Qualitative image quality scoring, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC value were evaluated. Friedman test with post hoc test revealed the difference across the three DWIs. Receiver operating characteristic analysis was performed to calculate the areas under the curve (AUCs). RESULTS The AUC of the rFOVSTA DWI and rFOVDLR DWI were higher than that of fFOV DWI. rFOVDLR DWI reduced the acquisition time from 5:02 min to 3:25 min, and showed higher scores in overall image quality with higher CNR and SNR, compared to rFOVSTA DWI (p < 0.05). The mean ADC of all cases of rFOVSTA DWI and rFOVDLR DWI was significantly lower than that of fFOV DWI (all p < 0.05). There was no difference in mean ADC value and the AUC for evaluating muscle invasion between rFOVSTA DWI and rFOVDLR DWI (p > 0.05). CONCLUSIONS rFOV DWI with DLR can improve the diagnostic accuracy of fFOV DWI for evaluating muscle invasion. Applying DLR to rFOV DWI reduced the acquisition time and improved overall image quality while maintaining ADC value and diagnostic accuracy. CRITICAL RELEVANCE STATEMENT The diagnostic performance and image quality of full field-of-view DWI, reduced field-of-view (rFOV) DWI with and without DLR were compared. DLR would benefit the wide clinical application of rFOV DWI by reducing the acquisition time and improving the image quality. KEY POINTS Deep learning reconstruction (DLR) can reduce scan time and improve image quality. Reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) with DLR showed better diagnostic performances than full field-of-view DWI. There was no difference of diagnostic accuracy between rFOV DWI with DLR and standard rFOV DWI.
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Affiliation(s)
- Xinxin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaojuan Xu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yichen Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Mancang Hu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lianyu Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Sicong Wang
- GE Healthcare, MR Research China, Daxing district, Tongji south road No1, Beijing, 100176, China
| | - Yi Li
- School of Statistics and Mathematics, Nanjing Audit University, Nanjing, 211815, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yan Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Fan Z, Guo J, Zhang X, Chen Z, Wang B, Jiang Y, Li Y, Wang Y, Yang G, Wang X. Non-Gaussian diffusion metrics with whole-tumor histogram analysis for bladder cancer diagnosis: muscle invasion and histological grade. Insights Imaging 2024; 15:138. [PMID: 38853200 PMCID: PMC11162990 DOI: 10.1186/s13244-024-01701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/13/2024] [Indexed: 06/11/2024] Open
Abstract
PURPOSE To investigate the performance of histogram features of non-Gaussian diffusion metrics for diagnosing muscle invasion and histological grade in bladder cancer (BCa). METHODS Patients were prospectively allocated to MR scanner1 (training cohort) or MR2 (testing cohort) for conventional diffusion-weighted imaging (DWIconv) and multi-b-value DWI. Metrics of continuous time random walk (CTRW), diffusion kurtosis imaging (DKI), fractional-order calculus (FROC), intravoxel incoherent motion (IVIM), and stretched exponential model (SEM) were simultaneously calculated using multi-b-value DWI. Whole-tumor histogram features were extracted from DWIconv and non-Gaussian diffusion metrics for logistic regression analysis to develop diffusion models diagnosing muscle invasion and histological grade. The models' performances were quantified by area under the receiver operating characteristic curve (AUC). RESULTS MR1 included 267 pathologically-confirmed BCa patients (median age, 67 years [IQR, 46-82], 222 men) and MR2 included 83 (median age, 65 years [IQR, 31-82], 73 men). For discriminating muscle invasion, CTRW achieved the highest testing AUC of 0.915, higher than DWIconv's 0.805 (p = 0.014), and similar to the combined diffusion model's AUC of 0.885 (p = 0.076). For differentiating histological grade of non-muscle-invasion bladder cancer, IVIM outperformed a testing AUC of 0.897, higher than DWIconv's 0.694 (p = 0.020), and similar to the combined diffusion model's AUC of 0.917 (p = 0.650). In both tasks, DKI, FROC, and SEM failed to show diagnostic superiority over DWIconv (p > 0.05). CONCLUSION CTRW and IVIM are two potential non-Gaussian diffusion models to improve the MRI application in assessing muscle invasion and histological grade of BCa, respectively. CRITICAL RELEVANCE STATEMENT Our study validates non-Gaussian diffusion imaging as a reliable, non-invasive technique for early assessment of muscle invasion and histological grade in BCa, enhancing accuracy in diagnosis and improving MRI application in BCa diagnostic procedures. KEY POINTS Muscular invasion largely determines bladder salvageability in bladder cancer patients. Evaluated non-Gaussian diffusion metrics surpassed DWIconv in BCa muscle invasion and histological grade diagnosis. Non-Gaussian diffusion imaging improved MRI application in preoperative diagnosis of BCa.
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Affiliation(s)
- Zhichang Fan
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Junting Guo
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaoyue Zhang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zeke Chen
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bin Wang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yueluan Jiang
- Department of MR Research Collaboration, Siemens Healthineers, Beijing, China
| | - Yan Li
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yongfang Wang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Guoqiang Yang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaochun Wang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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Kong L, Li H, Cai Q, Cao W, Chen Y, Weng B, Li M, Zhang M, Qian L, Guo Y, Ling J, Wen Z, Wang H. Amide Proton Transfer-Weighted Imaging in Assessing the Aggressive and Proliferative Potential of Bladder Cancer. J Magn Reson Imaging 2024. [PMID: 38822655 DOI: 10.1002/jmri.29464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Ki-67 and human epidermal growth factor receptor 2 (HER2) are known oncogenes involved in bladder cancer (BCa) patient risk stratification. Preoperative assessment of their expression level can assist in clinical treatment decision-making. Recently, amide proton transfer-weighted (APTw) MRI has shown promising potential in the diagnosis of several malignancies. However, few studies reported the value of APTw imaging in evaluating Ki-67 and HER2 status of BCa. PURPOSE To investigate the feasibility of APTw MRI in assessing the aggressive and proliferative potential regarding the expression levels of Ki-67 and HER2 in BCa. STUDY TYPE Retrospective. SUBJECTS 114 patients (mean age, 64.78 ± 11.93 [SD] years; 97 men) were studied. FIELD STRENGTH/SEQUENCE APTw MRI acquired by a three-dimensional fast-spin-echo sequence at 3.0 T MRI system. ASSESSMENT Patient pathologic findings, included histologic grade and the expression status of Ki-67 and HER2, were reviewed by one uropathologist. The APTw values of BCa were independently measured by two radiologists and were compared between high-/low-tumor grade group, high-/low-Ki-67 expression group, and high-/low-HER2 expression group. STATISTICAL TESTS The interclass correlation coefficient, independent sample t-test, Mann-Whitney U test, Spearman's rank correlation, and receiver operating characteristic curve (ROC) analysis were used. P < 0.05 was considered statistically significant. RESULTS Significantly higher APTw values were found in high-grade BCa patients (7.72% vs. 4.29%, P < 0.001), high-Ki-67 expression BCa patients (8.40% vs. 3.25%, P < 0.001) and HER2 positive BCa patients (8.24% vs. 5.40%, P = 0.001). APTw values were positively correlated with Ki-67 (r = 0.769) and HER2 (r = 0. 356) expression status. The area under the ROC curve of the APTw values for detecting Ki-67 and HER2 expression status were 0.883 (95% CI: 0.790-0.945) and 0.713 (95% CI: 0.592-0.816), respectively. DATA CONCLUSIONS APTw MRI is a potential method to assess the biological and proliferation potential of BCa. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Lingmin Kong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hui Li
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qian Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenxin Cao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bei Weng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Meiqin Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Min Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Long Qian
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jian Ling
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhihua Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Grobet-Jeandin E, Lenfant L, Pinar U, Parra J, Mozer P, Renard-Penna R, Thibault C, Rouprêt M, Seisen T. Management of patients with muscle-invasive bladder cancer with clinical evidence of pelvic lymph node metastases. Nat Rev Urol 2024; 21:339-356. [PMID: 38297079 DOI: 10.1038/s41585-023-00842-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
Identification of clinically positive pelvic lymph node metastases (cN+) in patients with muscle-invasive bladder cancer is currently challenging, as the diagnostic accuracy of available imaging modalities is limited. Conventional CT is still considered the gold-standard approach to diagnose lymph node metastases in these patients. The development of innovative diagnostic methods including radiomics, artificial intelligence-based models and molecular biomarkers might offer new perspectives for the diagnosis of cN+ disease. With regard to the treatment of these patients, multimodal strategies are likely to provide the best oncological outcomes, especially using induction chemotherapy followed by radical cystectomy and pelvic lymph node dissection in responders to chemotherapy. Additionally, the use of adjuvant nivolumab has been shown to decrease the risk of recurrence in patients who still harbour ypT2-T4a and/or ypN+ disease after surgery. Alternatively, the use of avelumab maintenance therapy can be offered to patients with unresectable cN+ tumours who have at least stable disease after induction chemotherapy alone. Lastly, patients with cN+ tumours who are not responding to induction chemotherapy are potential candidates for receiving second-line treatment with pembrolizumab.
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Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Louis Lenfant
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Jérôme Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Pierre Mozer
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Raphaele Renard-Penna
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Radiology, 75013, Paris, France
| | - Constance Thibault
- Department of medical oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP centre, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France.
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Li L, Zhang J, Zhe X, Tang M, Zhang L, Lei X, Zhang X. Prediction of histopathologic grades of bladder cancer with radiomics based on MRI: Comparison with traditional MRI. Urol Oncol 2024; 42:176.e9-176.e20. [PMID: 38556403 DOI: 10.1016/j.urolonc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To compare biparametric magnetic resonance imaging (bp-MRI) radiomics signatures and traditional MRI model for the preoperative prediction of bladder cancer (BCa) grade. MATERIALS AND METHODS This retrospective study included 255 consecutive patients with pathologically confirmed 113 low-grade and 142 high-grade BCa. The traditional MRI nomogram model was developed using univariate and multivariate logistic regression by the mean apparent diffusion coefficient (ADC), vesical imaging reporting and data system, tumor size, and the number of tumors. Volumes of interest were manually drawn on T2-weighted imaging (T2WI) and ADC maps by 2 radiologists. Using one-way analysis of variance, correlation, and least absolute shrinkage and selection operator methods to select features. Then, a logistic regression classifier was used to develop the radiomics signatures. Receiver operating characteristic (ROC) analysis was used to compare the diagnostic abilities of the radiomics and traditional MRI models by the DeLong test. Finally, decision curve analysis was performed by estimating the clinical usefulness of the 2 models. RESULTS The area under the ROC curves (AUCs) of the traditional MRI model were 0.841 in the training cohort and 0.806 in the validation cohort. The AUCs of the 3 groups of radiomics model [ADC, T2WI, bp-MRI (ADC and T2WI)] were 0.888, 0.875, and 0.899 in the training cohort and 0.863, 0.805, and 0.867 in the validation cohort, respectively. The combined radiomics model achieved higher AUCs than the traditional MRI model. decision curve analysis indicated that the radiomics model had higher net benefits than the traditional MRI model. CONCLUSION The bp-MRI radiomics model may help distinguish high-grade and low-grade BCa and outperforming the traditional MRI model. Multicenter validation is needed to acquire high-level evidence for its clinical application.
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Affiliation(s)
- Longchao Li
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jing Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Xia Zhe
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Li Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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12
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Xu X, Huang Y, Liu Y, Cai Q, Guo Y, Wang H, Lu H. Multiparametric MRI-based VI-RADS: can it predict 1- to 5-year recurrence of bladder cancer? Eur Radiol 2024; 34:3034-3045. [PMID: 37926742 DOI: 10.1007/s00330-023-10387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To evaluate whether Vesical Imaging-Reporting And Data System (VI-RADS) scores based on multiparametric MRI (mp-MRI) can predict bladder cancer (BCa) recurrence. METHODS In this retrospective study, 284 patients with pathologically confirmed bladder neoplasms from November 2011 to October 2020 were included. Two radiologists blindly and independently scored mp-MRI scans according to VI-RADS. Scoring inconsistency was resolved in consensus. The latest follow-up was completed in December 2022. Pearson's correlation analyses, independent-sample t-tests, and receiver operating characteristic analyses were performed to assess the efficacy of VI-RADS score for the 1- to 5-year recurrence prognostication. RESULTS Based on the latest follow-up, 37 (of 284, 13.0%), 69 (of 284, 24.3%), 70 (of 234, 29.9%), 72 (of 190, 37.9%), and 63 (of 135, 46.7%) patients had cancer recurrence at 1- to 5-year follow-up, respectively. VI-RADS scores showed significantly intergroup differences between recurrent and nonrecurrent cases during 1- to 4-year surveillance (p < 0.05). The recurrence-free survival was significantly higher in patients with VI-RADS scores of 1 or 2, compared to those with scores of 3, 4, or 5 (p < 0.05). Areas under the receiver operating characteristic curves for 1- to 5-year recurrence prediction were 0.744, 0.686, 0.656, 0.595, and 0.536, respectively. VI-RADS score of 3 or more was the threshold for 1-year recurrence assessment, and VI-RADS more than 3 was the cutoff for 2-year recurrence prediction. CONCLUSION VI-RADS score has potential in preoperative prognostication of BCa recurrence, but its predictive power decreases over time. CLINICAL RELEVANCE STATEMENT VI-RADS has potential in bladder cancer recurrence assessment, but its prognostic value decreases over time. Patients with VI-RADS ≥ 3 may be more likely to recur in 1 or 2 years postoperatively, thus should be performed with intensive surveillances. KEY POINTS • VI-RADS scores had significant differences in 1- to 4-year recurrent and nonrecurrent patient groups. • Patients with VI-RADS scores of ≤ 2 showed more favorable recurrence-free survival outcomes. • The prognostic value of VI-RADS score decreased over time for bladder cancer recurrence prediction.
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Affiliation(s)
- Xiaopan Xu
- School of Biomedical Engineering, Fourth Military Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, People's Republic of China
| | - Yiping Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Yang Liu
- School of Biomedical Engineering, Fourth Military Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, People's Republic of China
| | - Qian Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China.
| | - Hongbing Lu
- School of Biomedical Engineering, Fourth Military Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, People's Republic of China.
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13
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Cao B, Li Q, Xu P, Zhang Y, Cai S, Rao S, Zeng M, Dai Y, Jiang S, Zhou J. Vesical Imaging-Reporting and Data System (VI-RADS) as a grouping imaging biomarker combined with a decision-tree mode to preoperatively predict the pathological grade of bladder cancer. Clin Radiol 2024; 79:e725-e735. [PMID: 38360514 DOI: 10.1016/j.crad.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
AIM To investigate whether the Vesical Imaging-Reporting and Data System (VI-RADS) could be used to develop a new non-invasive preoperative grade-prediction system to partially predict high-grade bladder cancer (HG-BC). MATERIALS AND METHODS The present study enrolled 89 primary BC patients prospectively from March 2022 to June 2023. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of VI-RADS for predicting HG-BC and muscle-invasive bladder cancer (MIBC) in the entire group. In the low VI-RADS (≤2) group, the decision tree-based method was used to obtain significant predictors and construct the decision-tree model (DT model). The performance of the DT model and low VI-RADS scores for predicting HG-BC was determined using ROC, calibration, and decision curve analyses. RESULTS At a cut-off of ≥3, the specificity and positive predictive value of VI-RADS for predicting HG-BC in the entire group was 100%, and the area under the ROC curve (AUC) was 0.697. Among 65 patients with low VI-RADS scores, the DT model showed an AUC of 0.884 in predicting HG-BC compared to 0.506 for low VI-RADS scores. Calibration and decision curve analyses showed that the DT model performed better than the low VI-RADS scores. CONCLUSION Most VI-RADS scores ≥3 correspond to HG-BCs. VI-RADS could be used as a grouping imaging biomarker for a pathological grade-prediction procedure, which in combination with the DT model for low VI-RADS (≤2) populations, would provide a potential preoperative non-invasive method of predicting HG-BC.
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Affiliation(s)
- B Cao
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Q Li
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - P Xu
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China
| | - Y Zhang
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - S Cai
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - S Rao
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - M Zeng
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Y Dai
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - S Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Urology, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China.
| | - J Zhou
- Department of Radiology, Fudan University Zhongshan Hospital Xiamen Branch, Xiamen, China; Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China; Xiamen Key Clinical Specialty for Radiology, Xiamen, China.
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14
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Chai JL, Roller LA, Liu X, Lan Z, Mossanen M, Silverman SG, Shinagare AB. Performance of VI-RADS in predicting muscle-invasive bladder cancer after transurethral resection: a single center retrospective analysis. Abdom Radiol (NY) 2024; 49:1593-1602. [PMID: 38502214 DOI: 10.1007/s00261-024-04245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To assess VIRADS performance and inter-reader agreement for detecting muscle-invasive bladder cancer (MIBC) following transurethral resection of bladder tumor (TURBT). METHODS An IRB-approved, HIPAA-compliant, retrospective study from 2016 to 2020 included patients with bladder urothelial carcinoma who underwent MRI after TURBT, and cystectomy within 3 months without post-MRI treatments. Three radiologists blinded to pathology results independently reviewed MR images and assigned a VI-RADS score. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of VI-RADS were assessed for diagnosing MIBC using VI-RADS scores ≥ 3 and ≥ 4. Inter-reader agreement was assessed using Gwet's agreement coefficient (AC) and percent agreement. RESULTS The cohort consisted of 70 patients (mean age, 68 years ± 11 [SD]; range 39-85; 58 men) and included 32/70 (46%) with MIBC at cystectomy. ROC analysis revealed an AUC ranging from 0.67 to 0.77 and no pairwise statistical difference between readers (p-values, 0.06, 0.08, 0.97). Percent sensitivity, specificity, PPV, NPV and accuracy for diagnosing MIBC for the three readers ranged from 81.3-93.8, 36.8-55.3, 55.6-60.5, 77.3-87.5, and 62.9-67.1 respectively for VI-RADS score ≥ 3, and 78.1-81.3, 47.4-68.4, 55.6-67.6, 72.0-78.8 and 61.4-72.9 respectively for VI-RADS score ≥ 4. Gwet's AC was 0.63 [95% confidence interval (CI): 0.49,0.78] for VI-RADS score ≥ 3 with 79% agreement [95% CI 72,87] and 0.54 [95%CI 0.38,0.70] for VI-RADS score ≥ 4 with 76% agreement [95% CI 69,84]. VIRADS performance was not statistically different among 31/70 (44%) patients who received treatments prior to MRI (p ≥ 0.16). CONCLUSION VI-RADS had moderate sensitivity and accuracy but low specificity for detection of MIBC following TURBT, with moderate inter-reader agreement.
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Affiliation(s)
- Jessie L Chai
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Lauren A Roller
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Xiaoyang Liu
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Zhou Lan
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Matthew Mossanen
- Department of Urology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Atul B Shinagare
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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15
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Tsili AC. VI-RADS scoring system for predicting 1- to 5-year recurrence of bladder cancer. Eur Radiol 2024; 34:3032-3033. [PMID: 37999729 DOI: 10.1007/s00330-023-10458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
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Zhang X, Wang Y, Xu X, Zhang J, Sun Y, Hu M, Wang S, Li Y, Chen Y, Zhao X. Bladder MRI with deep learning-based reconstruction: a prospective evaluation of muscle invasiveness using VI-RADS. Abdom Radiol (NY) 2024; 49:1615-1625. [PMID: 38652125 DOI: 10.1007/s00261-024-04280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate the influence of deep learning reconstruction (DLR) on bladder MRI, specifically examination time, image quality, and diagnostic performance of vesical imaging reporting and data system (VI-RADS) within a prospective clinical cohort. METHODS Seventy participants with bladder cancer who underwent MRI between August 2022 and February 2023 with a protocol containing standard T2-weighted imaging (T2WIS), standard diffusion-weighted imaging (DWIS), fast T2WI with DLR (T2WIDL), and fast DWI with DLR (DWIDL) were enrolled in this prospective study. Imaging quality was evaluated by measuring signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and qualitative image quality scoring. Additionally, the apparent diffusion coefficient (ADC) of bladder lesions derived from DWIS and DWIDL was measured and VI-RADS scoring was performed. Paired t-test or paired Wilcoxon signed-rank test were performed to compare image quality score, SNR, CNR, and ADC between standard sequences and fast sequences with DLR. The diagnostic performance for VI-RADS was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Compared to T2WIS and DWIS, T2WIDL and DWIDL reduced the acquisition time from 5:57 min to 3:13 min and showed significantly higher SNR, CNR, qualitative image quality score of overall image quality, image sharpness, and lesion conspicuity. There were no significant differences in ADC and AUC of VI-RADS between standard sequences and fast sequences with DLR. CONCLUSIONS The application of DLR to T2WI and DWI reduced examination time and significantly improved image quality, maintaining ADC and the diagnostic performance of VI-RADS for evaluating muscle invasion in bladder cancer.
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Affiliation(s)
- Xinxin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yichen Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xiaojuan Xu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jie Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yuying Sun
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Mancang Hu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Sicong Wang
- GE Healthcare, MR Research China, Tongji South Road No1, Beijing, 100176, China
| | - Yi Li
- School of Statistics and Mathematics, Nanjing Audit University, Nanjing, 211815, China
| | - Yan Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Ben-David R, Galsky MD, Sfakianos JP. Novel bladder-sparing approaches in patients with muscle-invasive bladder cancer. Trends Mol Med 2024:S1471-4914(24)00092-3. [PMID: 38692938 DOI: 10.1016/j.molmed.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 05/03/2024]
Abstract
The pursuit of surgeons and oncologists in fulfilling the inherent desire of patients to retain their urinary bladder despite having muscle-invasive bladder cancer (MIBC) has sparked years of research and multiple debates, given its aggressive nature and the high risk of fatal metastatic recurrence. Historically, several approaches to bladder-sparing treatment have been explored, ranging from radical transurethral resection to concurrent chemoradiation. A less well-established approach involves a risk-adapted approach with local therapy deferred based on the clinical response to transurethral resection followed by systemic therapy. Each approach is associated with potential risks, benefits, and trade-offs. In this review, we aim to understand, navigate, and suggest future perspectives on bladder-sparing approaches in patients with MIBC.
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Affiliation(s)
- Reuben Ben-David
- Department of Urology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA.
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
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Zhang X, Wang Y, Wang Y, Zhang J, Zhang J, Zhang L, Wang S, Shou J, Chen Y, Zhao X. MRI evaluation of vesical imaging reporting and data system for bladder cancer after neoadjuvant chemotherapy. Cancer Imaging 2024; 24:49. [PMID: 38584289 PMCID: PMC11000365 DOI: 10.1186/s40644-024-00696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The Vesical Imaging-Reporting and Data System (VI-RADS) has demonstrated effectiveness in predicting muscle invasion in bladder cancer before treatment. The urgent need currently is to evaluate the muscle invasion status after neoadjuvant chemotherapy (NAC) for bladder cancer. This study aims to ascertain the accuracy of VI-RADS in detecting muscle invasion post-NAC treatment and assess its diagnostic performance across readers with varying experience levels. METHODS In this retrospective study, patients with muscle-invasive bladder cancer who underwent magnetic resonance imaging (MRI) after NAC from September 2015 to September 2018 were included. VI-RADS scores were independently assessed by five radiologists, consisting of three experienced in bladder MRI and two inexperienced radiologists. Comparison of VI-RADS scores was made with postoperative histopathological diagnosis. Receiver operating characteristic curve analysis (ROC) was used for evaluating diagnostic performance, calculating sensitivity, specificity, and area under ROC (AUC)). Interobserver agreement was assessed using the weighted kappa statistic. RESULTS The final analysis included 46 patients (mean age: 61 years ± 9 [standard deviation]; age range: 39-70 years; 42 men). The pooled AUC for predicting muscle invasion was 0.945 (95% confidence interval (CI): 0.893-0.977) for experienced readers, and 0.910 (95% CI: 0.831-0.959) for inexperienced readers, and 0.932 (95% CI: 0.892-0.961) for all readers. At an optimal cut-off value ≥ 4, pooled sensitivity and specificity were 74.1% (range: 66.0-80.9%) and 94.1% (range: 88.6-97.7%) for experienced readers, and 63.9% (range: 59.6-68.1%) and 86.4% (range: 84.1-88.6%) for inexperienced readers. Interobserver agreement ranged from substantial to excellent between all readers (k = 0.79-0.92). CONCLUSIONS VI-RADS accurately assesses muscle invasion in bladder cancer patients after NAC and exhibits good diagnostic performance across readers with different experience levels.
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Affiliation(s)
- Xinxin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yichen Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yilin Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jie Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Lianyu Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Sicong Wang
- GE Healthcare, MR Research China, Beijing, 100176, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Yan Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Kawaguchi M, Kato H, Koie T, Noda Y, Hyodo F, Miyazaki T, Matsuo M. CT and MRI findings of small cell neuroendocrine carcinoma of the urinary bladder: comparison with urothelial carcinoma. Abdom Radiol (NY) 2024:10.1007/s00261-024-04274-z. [PMID: 38584191 DOI: 10.1007/s00261-024-04274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of CT and MRI findings to differentiate small cell neuroendocrine carcinoma (SCNEC) from urothelial carcinoma (UC) of the urinary bladder. MATERIALS AND METHODS This study included 90 patients with histopathologically confirmed bladder cancer (10 SCNECs and 80 UCs). Eight patients with bladder SCNEC and 80 with UC underwent CT and MRI, whereas the remaining two patients with SCNEC underwent CT alone before treatment. CT and MRI findings were retrospectively evaluated and compared between the two pathologies. RESULTS The maximum diameter (36.5 mm vs. 19.0 mm, p < 0.01) and height (22.0 mm vs. 14.0 mm, p < 0.01) of the tumor in bladder SCNEC were higher than in UC. The pedunculated configuration (20% vs. 61%, p < 0.05) and irregular tumor margins (20% vs. 76%, p < 0.01) in bladder SCNEC were less common than in UC. The CT attenuation of the solid component in unenhanced CT images was higher in bladder SCNEC than in UC (37 Hounsfield unit [HU] vs. 34 HU, p < 0.01). The apparent diffusion coefficient (ADC) of the solid component in bladder SCNEC was lower than in UC (0.49 × 10-3 mm2/s vs. 1.02 × 10-3 mm2/s, p < 0.01). CONCLUSION In comparison with UC, bladder SCNEC was larger, had higher unenhanced CT attenuation, and had a lower ADC value. The pedunculated configuration and irregular tumor margins were typical of bladder UC.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
- Department of Radiology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, 503-0864, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takuya Koie
- Department of Urology, Gifu University, Gifu, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
- Center for One Medicine Innovative Translational Research (COMIT), Institute for Advanced Study, Gifu University, Gifu, Japan
| | | | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Takeuchi M. Editorial for "A Nomogram of MRI Features to Assess Muscle Invasion in VI-RADS 2 Tumors With Stalk". J Magn Reson Imaging 2024; 59:1191-1192. [PMID: 37555713 DOI: 10.1002/jmri.28922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 08/10/2023] Open
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21
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Panebianco V, Briganti A, Boellaard TN, Catto J, Comperat E, Efstathiou J, van der Heijden AG, Giannarini G, Girometti R, Mertens L, Takeuchi M, Muglia VF, Narumi Y, Novara G, Pecoraro M, Roupret M, Sanguedolce F, Santini D, Shariat SF, Simone G, Vargas HA, Woo S, Barentsz J, Witjes JA. Clinical application of bladder MRI and the Vesical Imaging-Reporting and Data System. Nat Rev Urol 2024; 21:243-251. [PMID: 38036666 DOI: 10.1038/s41585-023-00830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic work-up and risk stratification in patients with bladder cancer before and after treatment must be refined to optimize management and improve outcomes. MRI has been suggested as a non-invasive technique for bladder cancer staging and assessment of response to systemic therapy. The Vesical Imaging-Reporting And Data System (VI-RADS) was developed to standardize bladder MRI image acquisition, interpretation and reporting and enables accurate prediction of muscle-wall invasion of bladder cancer. MRI is available in many centres but is not yet recommended as a first-line test for bladder cancer owing to a lack of high-quality evidence. Consensus-based evidence on the use of MRI-VI-RADS for bladder cancer care is needed to serve as a benchmark for formulating guidelines and research agendas until further evidence from randomized trials becomes available.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Eva Comperat
- Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France
| | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Laura Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Morgan Roupret
- Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Daniele Santini
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Giuseppe Simone
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jelle Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Cai L, Yu R, Liu P, Zhuang J, Li K, Wu Q, Sun X, Liu Y, Zhou M, Cao Q, Li P, Yang X, Lu Q. A Nomogram of MRI Features to Assess Muscle Invasion in VI-RADS 2 Tumors With Stalk. J Magn Reson Imaging 2024; 59:1179-1190. [PMID: 37602726 DOI: 10.1002/jmri.28924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Vesical Imaging-Reporting and Data System (VI-RADS) is widely used to assess the muscle-invasive status of bladder cancer. However, the current classification efficacy of VI-RASD 2 tumors of stalk is unsatisfactory. PURPOSE To develop a nomogram to assess muscle-invasive bladder cancer (MIBC) in VI-RADS 2 tumors with stalk. STUDY TYPE Retrospective. POPULATION A total of 186 patients (age: 67.8 ± 12.7 years) with 15.1% females, divided randomly into a training cohort (N = 130) and validation cohort (N = 56). FIELD STRENGTH/SEQUENCE 3-T, T2-weighted imaging (turbo spin-echo), diffusion-weighted imaging (breathing-free spin-echo), and dynamic contrast-enhanced imaging (gradient-echo). ASSESSMENT Twenty-one MRI features of tumors and stalks were developed from training cohort. The mean apparent diffusion coefficient (ADC) values of the tumor, stalk, and psoas muscles were calculated from the three circular regions of interest. The normalized T value = mean ADC tumor mean ADC muscle . The normalized ST value = mean ADC stalk mean ADC tumor . Three readers assessed the morphology of tumors and stalks. STATISTICAL TESTS The final features of nomogram were selected by univariable logistic and the least absolute shrinkage and selection operator (LASSO) regression. The performance of the nomogram was assessed by the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis. RESULTS In VI-RADS 2 tumors with stalk, tumor size over 3 cm, increased stalk width, stalk morphology, decreased normalized T value, and increased normalized ST value were selected as the risk factors for MIBC. The AUC, accuracy, sensitivity, and specificity of the nomogram to assess MIBC were 0.969 (95% CI: 0.941-0.997), 92.3%, 94.1%, and 92.0% in training cohort and 0.940 (95% CI: 0.859-1.000), 89.3%, 75.0%, and 91.7% in validation cohort. DATA CONCLUSION This study constructed a nomogram for preoperative assessment of MIBC and modifying the current VI-RADS. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Ruixi Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peikun Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Sun
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Liu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Zhou
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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23
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Klein C, Brunelle S, Illy M, De Luca V, Doisy L, Lannes F, Sypre D, Branger N, Maubon T, Rybikowski S, Guérin M, Gravis G, Walz J, Pignot G. Multiparametric Magnetic Resonance Imaging in the follow-up of non-muscle-invasive bladder tumors after intravesical instillations: a promising tool. World J Urol 2024; 42:178. [PMID: 38507101 DOI: 10.1007/s00345-024-04868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE The standard follow-up for non-muscle-invasive bladder cancer is based on cystoscopy. Unfortunately, post-instillation inflammatory changes can make the interpretation of this exam difficult, with lower specificity. This study aimed to evaluate the interest of bladder MRI in the follow-up of patients following intravesical instillation. METHODS Data from patients who underwent cystoscopy and bladder MRI in a post-intravesical instillation setting between February 2020 and March 2023 were retrospectively collected. Primary endpoint was to evaluate and compare the diagnostic performance of cystoscopy and bladder MRI in the overall cohort (n = 67) using the pathologic results of TURB as a reference. The secondary endpoint was to analyze the diagnostic accuracy of cystoscopy and bladder MRI according to the appearance of the lesion on cystoscopy [flat (n = 40) or papillary (n = 27)]. RESULTS The diagnostic performance of bladder MRI was better than that of cystoscopy, with a specificity of 47% (vs. 6%, p < 0.001), a negative predictive value of 88% (vs. 40%, p = 0.03), and a positive predictive value of 66% (vs. 51%, p < 0.001), whereas the sensitivity did not significantly differ between the two exams. In patients with doubtful cystoscopy and negative MRI findings, inflammatory changes were found on TURB in most cases (17/19). The superiority in MRI bladder performance prevailed for "flat lesions", while no significant difference was found for "papillary lesions". CONCLUSIONS In cases of doubtful cystoscopy after intravesical instillations, MRI appears to be relevant with good performance in differentiating post-therapeutic inflammatory changes from recurrent tumor lesions and could potentially allow avoiding unnecessary TURB.
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Affiliation(s)
- Clément Klein
- Urology Department, CHU Bordeaux, 33000, Bordeaux, France.
| | - Serge Brunelle
- Radiology Department, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Mathias Illy
- Radiology Department, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Valeria De Luca
- Radiology Department, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Laure Doisy
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - François Lannes
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Davidson Sypre
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Nicolas Branger
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Stanislas Rybikowski
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Mathilde Guérin
- Medical Oncology Department, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Gwenaëlle Gravis
- Medical Oncology Department, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Geraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
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Ikuma S, Akatsuka J, Takeda H, Endo Y, Kiriyama T, Hamasaki T, Kimura G, Kondo Y. Determining the clinicopathological significance of the VI-RADS ≧4 group: a retrospective study. BMC Urol 2024; 24:63. [PMID: 38509503 PMCID: PMC10953073 DOI: 10.1186/s12894-024-01452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The Vesical Imaging Reporting and Data System (VI-RADS) is widely used for predicting muscle-invasive bladder cancer (MIBC). This study aimed to determine the clinicopathological significance of the VI-RADS ≧4 (VI≧4) group. METHODS Patients who underwent transurethral resections of bladder tumors during the study period and preoperative magnetic resonance imaging were considered. The patients were pathologically diagnosed with urothelial carcinoma (UC). We first compared the results of patients with VI-RADS scores of 3 and 4 to determine the cut-off score for MIBC; thereafter, the patients were divided into the VI≧4 and VI-RADS ≦3 (VI≦3) groups using VI-RADS. The clinicopathological significance of the VI≧4 group was examined retrospectively by comparing the characteristics of each group. RESULTS In total, 121 cases were examined, of which 28 were pathologically diagnosed with MIBC. Of the 28 MIBC cases, three (10.7%) had a VI-RADS score of ≦3, and 25 (89.3%) had a VI-RADS score of ≧4. Of the 93 NMIBC cases, 86 (92.5%) had a VI-RADS score of ≦3, and seven (7.5%) had a VI-RADS score of ≧4. The diagnostic performance of the VI-RADS with a cut-off score of 4 was 89.3% for sensitivity, 92.5% for specificity, and an area under the curve (AUC) of 0.91. Contrastingly, for a cut-off score of 3, the sensitivity was 89.3%, specificity was 62.0%, and AUC was 0.72. A VI-RADS score of ≥ 4 could predict MIBC. In the VI≧4 group, 30 of 32 (93.8%) patients had high-grade tumors. The VI≧4 group had significantly more high-grade bladder cancers than the VI≦3 group (p < 0.001 OR = 31.77 95%CI:8.47-1119.07). In addition, the VI≧4 group had more tumor necrosis (VI≧4 vs VI≦3, p < 0.001 OR = 7.46 95%CI:2.61-21.34) and more UC variant cases (VI≧4 vs VI≦3, p = 0.034 OR = 3.28 95%CI:1.05-10.25) than the VI≦3 group. CONCLUSIONS This study suggests that VI-RADS has a high diagnostic performance in predicting MIBC and that VI-RADS could diagnose high-grade tumors, necrosis, and UC variants.
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Affiliation(s)
- Shunsuke Ikuma
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tomonari Kiriyama
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
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Tao T, Chen Y, Shang Y, He J, Hao J. SMMF: a self-attention-based multi-parametric MRI feature fusion framework for the diagnosis of bladder cancer grading. Front Oncol 2024; 14:1337186. [PMID: 38515574 PMCID: PMC10955083 DOI: 10.3389/fonc.2024.1337186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Background Multi-parametric magnetic resonance imaging (MP-MRI) may provide comprehensive information for graded diagnosis of bladder cancer (BCa). Nevertheless, existing methods ignore the complex correlation between these MRI sequences, failing to provide adequate information. Therefore, the main objective of this study is to enhance feature fusion and extract comprehensive features from MP-MRI using deep learning methods to achieve an accurate diagnosis of BCa grading. Methods In this study, a self-attention-based MP-MRI feature fusion framework (SMMF) is proposed to enhance the performance of the model by extracting and fusing features of both T2-weighted imaging (T2WI) and dynamic contrast-enhanced imaging (DCE) sequences. A new multiscale attention (MA) model is designed to embed into the neural network (CNN) end to further extract rich features from T2WI and DCE. Finally, a self-attention feature fusion strategy (SAFF) was used to effectively capture and fuse the common and complementary features of patients' MP-MRIs. Results In a clinically collected sample of 138 BCa patients, the SMMF network demonstrated superior performance compared to the existing deep learning-based bladder cancer grading model, with accuracy, F1 value, and AUC values of 0.9488, 0.9426, and 0.9459, respectively. Conclusion Our proposed SMMF framework combined with MP-MRI information can accurately predict the pathological grading of BCa and can better assist physicians in diagnosing BCa.
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Affiliation(s)
- Tingting Tao
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
| | - Ying Chen
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunyun Shang
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianfeng He
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
- School of Physics and Electronic Engineering, Yuxi Normal University, Yuxi, China
| | - Jingang Hao
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Hoegger MJ. Invited Commentary: VI-RADS and Routing Patient Care at the Muscularis Propria. Radiographics 2024; 44:e230234. [PMID: 38421910 DOI: 10.1148/rg.230234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Mark J Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110
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27
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Huang J, Chen G, Liu H, Jiang W, Mai S, Zhang L, Zeng H, Wu S, Chen CYC, Wu Z. MRI-based automated machine learning model for preoperative identification of variant histology in muscle-invasive bladder carcinoma. Eur Radiol 2024; 34:1804-1815. [PMID: 37658139 DOI: 10.1007/s00330-023-10137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES It is essential yet highly challenging to preoperatively diagnose variant histologies such as urothelial carcinoma with squamous differentiation (UC w/SD) from pure UC in patients with muscle-invasive bladder carcinoma (MIBC), as their treatment strategy varies significantly. We developed a non-invasive automated machine learning (AutoML) model to preoperatively differentiate UC w/SD from pure UC in patients with MIBC. METHODS A total of 119 MIBC patients who underwent baseline bladder MRI were enrolled in this study, including 38 patients with UC w/SD and 81 patients with pure UC. These patients were randomly assigned to a training set or a test set (3:1). An AutoML model was built from the training set, using 13 selected radiomic features from T2-weighted imaging, semantic features (ADC values), and clinical features (tumor length, tumor stage, lymph node metastasis status), and subsequent ten-fold cross-validation was performed. A test set was used to validate the proposed model. The AUC of the ROC curve was then calculated for the model. RESULTS This AutoML model enabled robust differentiation of UC w/SD and pure UC in patients with MIBC in both training set (ten-fold cross-validation AUC = 0.955, 95% confidence interval [CI]: 0.944-0.965) and test set (AUC = 0.932, 95% CI: 0.812-1.000). CONCLUSION The presented AutoML model, that incorporates the radiomic, semantic, and clinical features from baseline MRI, could be useful for preoperative differentiation of UC w/SD and pure UC. CLINICAL RELEVANCE STATEMENT This MRI-based automated machine learning (AutoML) study provides a non-invasive and low-cost preoperative prediction tool to identify the muscle-invasive bladder cancer patients with variant histology, which may serve as a useful tool for clinical decision-making. KEY POINTS • It is important to preoperatively diagnose variant histology from urothelial carcinoma in patients with muscle-invasive bladder carcinoma (MIBC), as their treatment strategy varies significantly. • An automated machine learning (AutoML) model based on baseline bladder MRI can identify the variant histology (squamous differentiation) from urothelial carcinoma preoperatively in patients with MIBC. • The developed AutoML model is a non-invasive and low-cost preoperative prediction tool, which may be useful for clinical decision-making.
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Affiliation(s)
- Jingwen Huang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Guanxing Chen
- Artificial Intelligence Medical Research Center, School of Intelligent Systems Engineering, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, China
| | - Haiqing Liu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Wei Jiang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Siyao Mai
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Lingli Zhang
- Department of Pathology, Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei, 516600, China
| | - Hong Zeng
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Shaoxu Wu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, 510120, China
| | - Calvin Yu-Chian Chen
- Artificial Intelligence Medical Research Center, School of Intelligent Systems Engineering, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, China.
- Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan.
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 41354, Taiwan.
| | - Zhuo Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, 510120, China.
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Fávero Prietto Dos Santos J, Ghezzi CLA, Pedrollo IM, Cruz ÍR, Orozco OFG, Zapparoli M, Schuch A, Muglia VF. Practical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and Pitfalls. Radiographics 2024; 44:e230149. [PMID: 38421912 DOI: 10.1148/rg.230149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Urothelial carcinoma is the most common type of bladder cancer (BC), accounting for approximately 90% of all cases. Evaluating the depth of tumor invasion in the bladder wall (tumor staging) is essential for determining the treatment and prognosis in patients with BC. Neoadjuvant therapy followed by radical cystectomy is the most common treatment of localized muscle-invasive BC (MIBC). Therefore, it is vital to differentiate non-MIBC from MIBC. Transurethral resection of bladder tumor (TURBT) is the reference standard to determine the extent of tumor invasion into the bladder wall through tissue sampling. However, this diagnostic and therapeutic method may not adequately sample the muscularis propria, leading to a higher risk of residual disease, early recurrence, and tumor understaging in approximately 50% of patients during the initial TURBT. Multiparametric MRI can overcome some of the limitations of TURBT when evaluating BC, particularly regarding tumor staging. In this context, the Vesical Imaging Reporting and Data System (VI-RADS) classification was developed to establish standards for bladder multiparametric MRI and interpretation. It uses a 5-point scale to assess the likelihood of detrusor muscle invasion. T2-weighted MR images are particularly useful as an initial guide, especially for categories 1-3, while the presence of muscular invasion is determined with diffusion-weighted and dynamic contrast-enhanced sequences. Diffusion-weighted imaging takes precedence as the dominant method when optimal image quality is achieved. The presence of a stalk or a thickened inner layer and no evidence of interruption of the signal intensity of the muscular layer are central for predicting a low likelihood of muscle invasion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Hoegger in this issue.
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Affiliation(s)
- Jônatas Fávero Prietto Dos Santos
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Caroline Lorenzoni Almeida Ghezzi
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ivan Morzoletto Pedrollo
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ítalo Ribeiro Cruz
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Oscar Fernando Ghattas Orozco
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Maurício Zapparoli
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Alice Schuch
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Valdair Francisco Muglia
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
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Yu J, Cai L, Chen C, Zou Y, Xiao Y, Fu X, Wang L, Yang X, Liu P, Lu Q, Sun X, Shao Q. A novel predict method for muscular invasion of bladder cancer based on 3D mp-MRI feature fusion. Phys Med Biol 2024; 69:055011. [PMID: 38306973 DOI: 10.1088/1361-6560/ad25c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/01/2024] [Indexed: 02/04/2024]
Abstract
Objective. To assist urologist and radiologist in the preoperative diagnosis of non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), we proposed a combination models strategy (CMS) utilizing multiparametric magnetic resonance imaging.Approach. The CMS includes three components: image registration, image segmentation, and multisequence feature fusion. To ensure spatial structure consistency of T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCE), a registration network based on patch sampling normalized mutual information was proposed to register DWI and DCE to T2WI. Moreover, to remove redundant information around the bladder, we employed a segmentation network to obtain the bladder and tumor regions from T2WI. Using the coordinate mapping from T2WI, we extracted these regions from DWI and DCE and integrated them into a three-branch dual-channel input. Finally, to fully fuse low-level and high-level features of T2WI, DWI, and DCE, we proposed a distributed multilayer fusion model for preoperative MIBC prediction with five-fold cross-validation.Main results. The study included 436 patients, of which 404 were for the internal cohort and 32 for external cohort. The MIBC was confirmed by pathological examination. In the internal cohort, the area under the curve, accuracy, sensitivity, and specificity achieved by our method were 0.928, 0.869, 0.753, and 0.929, respectively. For the urologist and radiologist, Vesical Imaging-Reporting and Data System score >3 was employed to determine MIBC. The urologist demonstrated an accuracy, sensitivity, and specificity of 0.842, 0.737, and 0.895, respectively, while the radiologist achieved 0.871, 0.803, and 0.906, respectively. In the external cohort, the accuracy of our method was 0.831, which was higher than that of the urologist (0.781) and the radiologist (0.813).Significance. Our proposed method achieved better diagnostic performance than urologist and was comparable to senior radiologist. These results indicate that CMS can effectively assist junior urologists and radiologists in diagnosing preoperative MIBC.
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Affiliation(s)
- Jie Yu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Lingkai Cai
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Chunxiao Chen
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Yuan Zou
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Yueyue Xiao
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xue Fu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Liang Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xiao Yang
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Peikun Liu
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Qiang Lu
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Xueying Sun
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Qiang Shao
- Department of Urology, the Affiliated Suzhou Hospital of Nanjing Medical University, People's Republic of China
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He K, Meng X, Wang Y, Feng C, Liu Z, Li Z, Niu Y. Progress of Multiparameter Magnetic Resonance Imaging in Bladder Cancer: A Comprehensive Literature Review. Diagnostics (Basel) 2024; 14:442. [PMID: 38396481 PMCID: PMC10888296 DOI: 10.3390/diagnostics14040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Magnetic resonance imaging (MRI) has been proven to be an indispensable imaging method in bladder cancer, and it can accurately identify muscular invasion of bladder cancer. Multiparameter MRI is a promising tool widely used for preoperative staging evaluation of bladder cancer. Vesical Imaging-Reporting and Data System (VI-RADS) scoring has proven to be a reliable tool for local staging of bladder cancer with high accuracy in preoperative staging, but VI-RADS still faces challenges and needs further improvement. Artificial intelligence (AI) holds great promise in improving the accuracy of diagnosis and predicting the prognosis of bladder cancer. Automated machine learning techniques based on radiomics features derived from MRI have been utilized in bladder cancer diagnosis and have demonstrated promising potential for practical implementation. Future work should focus on conducting more prospective, multicenter studies to validate the additional value of quantitative studies and optimize prediction models by combining other biomarkers, such as urine and serum biomarkers. This review assesses the value of multiparameter MRI in the accurate evaluation of muscular invasion of bladder cancer, as well as the current status and progress of its application in the evaluation of efficacy and prognosis.
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Affiliation(s)
- Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Cui Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Yonghua Niu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Tufano A, Rosati D, Moriconi M, Santarelli V, Canale V, Salciccia S, Sciarra A, Franco G, Cantisani V, Di Pierro GB. Diagnostic Accuracy of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Muscle-Invasive Bladder Cancer: A Systematic Review and Diagnostic Meta-Analysis. Curr Oncol 2024; 31:818-827. [PMID: 38392054 PMCID: PMC10888477 DOI: 10.3390/curroncol31020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a diagnostic tool that is gaining popularity for its ability to improve overall diagnostic accuracy in bladder cancer (BC) staging. Our aim is to determine the cumulative diagnostic performance of CEUS in predicting preoperative muscle invasiveness using a comprehensive systematic review and pooled meta-analysis. METHODS A systematic review until October 2023 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Patients with BC suspicion were offered CEUS before the transurethral resection of the bladder tumor (TURBT). The diagnostic performance of CEUS was evaluated based on non-muscle-invasive bladder cancer (NMIBC) vs. muscle-invasive bladder cancer (MIBC) confirmed at the final histopathological examination after TURBT. The outcomes were determined through pooled sensitivity, specificity, pooled positive likelihood ratio (PLR+), negative likelihood ratio (PLR-), and area under the summary receiver operating characteristic (SROC) along with their respective 95% confidence intervals (CI). RESULTS Overall, five studies were included. In these studies, a total of 362 patients underwent CEUS prior to TURBT. The pooled sensitivity and specificity were 0.88 (95% CI: 0.81-0.93) and 0.88 (95% CI: 0.82-0.92), respectively. SROC curve depicted a diagnostic accuracy of 0.94 (95% CI: 0.81-0.98). The pooled PLR+ and PLR- were 7.3 (95% CI: 4.8-11.2) and 0.14 (95% CI: 0.08-0.23), respectively. CONCLUSIONS Our meta-analysis indicates that CEUS is highly accurate in the diagnosis and staging for BC. Beyond its accuracy, CEUS offers the advantage of being a cost-effective, safe, and versatile imaging tool.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Davide Rosati
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Martina Moriconi
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Valerio Santarelli
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology and Pathology, University La Sapienza of Rome, 00185 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
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Necchi A, Basile G, Gibb EA, Raggi D, Calareso G, de Padua TC, Patanè D, Crupi E, Mercinelli C, Cigliola A, Tateo V, Giannatempo P, Moschini M, Briganti A, Montorsi F, Messina A, Ross JS, Pavlick D, De Cobelli F, Brembilla G. Vesical Imaging-Reporting and Data System use predicting the outcome of neoadjuvant pembrolizumab in muscle-invasive bladder cancer. BJU Int 2024; 133:214-222. [PMID: 37803523 DOI: 10.1111/bju.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To evaluate the predictive capability of the pre- and post-pembrolizumab Vesical Imaging-Reporting and Data System (VI-RADS) to identify ypT0N0 or ypT≤1N0 response in muscle-invasive bladder cancer (MIBC) within the PURE-01 trial (ClinicalTrials.gov identifier: NCT02736266). PATIENTS AND METHODS Patients were staged with bladder multiparametric magnetic resonance imaging (mpMRI) before and after treatment (three cycles of pembrolizumab) prior to radical cystectomy (RC). Logistic regression models were used to analyse the pre- and post- pembrolizumab VI-RADS against ypT≤1N0 and ypT0N0 response. The VI-RADS scores were dichotomised between 0 and 3 (0 = no evidence of disease) and 4-5. Event-free survival (EFS) and overall survival (OS) analyses were performed. Comprehensive genomic profiling and transcriptome-wide expression profiling data were matched with the VI-RADS scores. RESULTS In total, 110 patients underwent centrally reviewed scans (N = 220 mpMRI), treated between February 2017 and July 2020. Both pre- and post-pembrolizumab VI-RADS 0-3 scores were the only significant covariates that predicted the ypT≤1N0 endpoint in multivariable analyses, and the strongest effect was seen with post-pembrolizumab VI-RADS 0-3 predicting the ypT≤1N0 response (P < 0.001). The area under the curve for this model was 0.90. Post-pembrolizumab VI-RADS 0-3 also predicted a longer EFS (P < 0.001) and OS (P = 0.044). The scores of several gene signatures from baseline tumours differed between the pre-pembrolizumab VI-RADS 0-3 and 4-5 categories. CONCLUSION Post-pembrolizumab VI-RADS scores are strongly associated with pathological downstaging and survival. VI-RADS scores were also characterised by distinct biomarker features. These results indicate that the VI-RADS is emerging as an important tool for designing next-generation trials for MIBC.
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Affiliation(s)
- Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Basile
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Daniele Raggi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Damiano Patanè
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Crupi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Cigliola
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Moschini
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonella Messina
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jeffrey S Ross
- Foundation Medicine Inc, Cambridge, MA, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
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Tandon M, Chakraborty S, Barkondaj B, Choudhury S, Pal DK. Role of multiparametric MRI in predicting muscle invasiveness in urinary bladder neoplasms with pathological correlations. Urologia 2024; 91:55-60. [PMID: 37886848 DOI: 10.1177/03915603231204078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Urinary bladder cancer (BC) is one of the most frequent malignancies and the ninth most common malignancy worldwide. The objective of this study is to assess the role of multiparametric magnetic resonance imaging (mp-MRI) in predicting the invasiveness of urinary bladder space occupying lesions. Thirty-five patients diagnosed with bladder masses underwent an mp-MRI study. The results of three image sets were analysed and compared with the histopathological results as a reference standard: T2-weighted image (T2WI) plus dynamic contrast-enhanced (DCE), T2WI plus diffusion-weighted images (DWI), and mp-MRI, including T2WI plus DWI and DCE. The diagnostic accuracy of mp-MRI was evaluated using receiver operating characteristic curve analysis. We discovered a highly significant correlation between muscle invasiveness as staged by HPE (Histopathological examination) and mp-MRI utilising a VI-RADS score >3 (p 0.001) with a sensitivity of 100% and a specificity of 85.7%. With a diagnostic accuracy of 77.14%, a sensitivity of 92.31%, a specificity of 72.72%, a positive predictive value of 66.67%, and a negative predictive value of 94.11%, In terms of muscle invasiveness, there is good concordance between HPE staging and mp-MRI utilising the VI-RADS score. The mean apparent diffusion coefficient (ADC) values were higher in low grades than in high grades. The ROC curve study revealed a very strong correlation between HPE grade and ADC (p = 0.045). In 77.14% of patients, Mp-MRI correctly identified the local T stage. Mp-MRI is imaging biomarker for invasiveness and grade of tumour. The tumours with high grade are more invasive. However, the diagnostic accuracy of mp-MRI in determining muscle invasiveness is not very high and it overstages the disease in some cases (33.3%). Its clinical usefulness in determining muscle invasiveness before TURBT and histopathological examination can be questioned.
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Affiliation(s)
- Mrinal Tandon
- Department of Urology, IPGME&R, Kolkata, West Bengal, India
| | | | | | - Sunirmal Choudhury
- Department of urology, Medical College Hospital, Kolkata, West Bengal, India
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Kong L, Wen Z, Cai Q, Lin Y, Chen Y, Cao W, Li M, Qian L, Chen J, Guo Y, Wang H. Amide Proton Transfer-Weighted MRI and Diffusion-Weighted Imaging in Bladder Cancer: A Complementary Tool to the VI-RADS. Acad Radiol 2024; 31:564-571. [PMID: 37821347 DOI: 10.1016/j.acra.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/27/2023] [Accepted: 09/03/2023] [Indexed: 10/13/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of amide proton transfer-weighted (APTw) and diffusion-weighted Magnetic Resonance Imaging (MRI) as a means by which to add value to the Vesical Imaging Reporting and Data System (VI-RADS) for discriminating muscle invasive bladder cancer (MIBC) from nonmuscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS This prospective study enrolled participants with pathologically confirmed bladder cancer (BCa) who underwent preoperative multiparametric MRI, including APTw and diffusion-weighted MRI, from July 2020 to January 2023. The exclusion criteria were lesions smaller than 10 mm, missing smooth muscle layer in the operation specimen, neoadjuvant therapy before MRI, inadequate image quality, and malignancy other than urothelial neoplasm. Two radiologists independently assigned the VI-RADS score for each participant. Quantitative parameters derived from APTw and diffusion-weighted MRI were obtained by another two radiologists. Receiver operating characteristic (ROC) curve analysis with the area under the ROC curve (AUC) was performed to evaluate the diagnostic performances of quantitative parameters for discriminating BCa detrusor muscle invasion status. RESULTS A total of 106 participants were enrolled (mean age, 64 ± 12 years [SD]; 90 men): 32 with MIBC and 74 with NMIBC. Lower apparent diffusion coefficient (ADC) values (0.88 × 10-3 mm2/s ± 0.12 vs. 1.08 × 10-3 mm2/s ± 0.25; P < 0.001) and higher APTw values (6.89% [interquartile range {IQR}, 5.05%-12.17%] vs. 3.61% [IQR, 2.23%-6.83%]; P < 0.001) were observed in the MIBC group. Compared to VI-RADS alone, both APTw (P = 0.003) and ADC (P = 0.020) values could improve the diagnostic performance of VI-RADS in differentiating MIBC from NMIBC. The combination of the three yielded the highest diagnostic performance (AUC, 0.93; 95% CI:0.87,0.97) for evaluating muscle invasion status. The addition of the APTw values to the combination of VI-RADS and ADC values notably improved the diagnostic performance for differentiating NMIBC from MIBC (VI-RADS+ADC vs. VI-RADS+APTw+ADC, P = 0.046). CONCLUSION MRI parameters derived from APTw and diffusion-weighted MRI can be used to accurately assess muscle invasion status in BCa and provide additional value to VI-RADS.
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Affiliation(s)
- Lingmin Kong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Zhihua Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Qian Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Yingyu Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Wenxin Cao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Meiqin Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Long Qian
- MR Research, GE Healthcare, Beijing, China (L.Q.)
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (J.C.)
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.).
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Onder RO, Aslan S, Bekci T. Prevalence of Bladder Cancers Incidentally Detected During Multiparametric MRI Scans of the Prostate Gland and the Clinical Significance of Scoring Them According to VI-RADS: A Pictorial Single-Centre Study. J Belg Soc Radiol 2024; 108:7. [PMID: 38312149 PMCID: PMC10836167 DOI: 10.5334/jbsr.3318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose To determine the prevalence of incidentally detected bladder cancers (BCs) on multiparametric magnetic resonance imaging (mpMRI) of the prostate and to highlight the clinical importance of scoring them according to the Vesical Imaging-Reporting and Data System (VI-RADS). Materials and Methods VI-RADS scores for incidental bladder lesions on mpMRI of the prostate were collected in 1693 patients with elevated prostate-specific antigen but no hematuria. The study included 19 patients with 28 incidental bladder lesions. Results During this period, 39 incidental bladder lesions were found in 30 patients, representing 1.7% of cases. Of the 28 lesions, 11 were categorized by VI-RADS as VI-RADS 1, 14 as VI-RADS 2, 1 as VI-RADS 3, 1 as VI-RADS 4, and 1 as VI-RADS 5. Histopathological examination revealed 1 benign lesion, 24 non-muscle invasive BCs, and 3 muscle-invasive BCs in the 19 patients. Impressively, 97% of the incidental lesions detected by prostate mpMRI and categorized by VI-RADS were BCs without apparent prostate cancer invasion. Notably, 93% of these lesions were consistent with histopathological findings of muscle invasion and extravesical spread. Conclusion Our study concludes the prevalence 1% incidental BC in prostate mpMRI. The research underscores a thorough bladder examination during prostate MRI scans. Utilizing mpMRI assists in distinguishing varying BC stages, aiding treatment decisions, and patient outcomes. VI-RADS categorization aligns with histopathological results, enhancing diagnosis, and healthcare communication. Early detection significantly influences patient care by enabling timely interventions and suitable treatment strategies, particularly for low-stage BCs linked to reduced progression and recurrence rates.
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Affiliation(s)
- Ramazan Orkun Onder
- Faculty of Medicine, Department of Radiology, Giresun University, Giresun, Turkey
| | - Serdar Aslan
- Faculty of Medicine, Department of Radiology, Giresun University, Giresun, Turkey
| | - Tümay Bekci
- Faculty of Medicine, Department of Radiology, Giresun University, Giresun, Turkey
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Dekkers IA, Karst U, Stroomberg G, Clement O, Gianolio E, Nederveen AJ, Radbruch A, Quattrocchi CC. The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS). MAGMA (NEW YORK, N.Y.) 2024; 37:15-25. [PMID: 37702845 PMCID: PMC10876744 DOI: 10.1007/s10334-023-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023]
Abstract
Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 48, 48149, Münster, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Olivier Clement
- Service de Radiologie, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, 20 Rue LeBlanc, 75015, Paris, France
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Via Nizza 52, 10125, Turin, Italy
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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Wei Z, Liu H, Xv Y, Liao F, He Q, Xie Y, Lv F, Jiang Q, Xiao M. Development and validation of a CT-based deep learning radiomics nomogram to predict muscle invasion in bladder cancer. Heliyon 2024; 10:e24878. [PMID: 38304824 PMCID: PMC10831750 DOI: 10.1016/j.heliyon.2024.e24878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
Objective This study aimed to develop a nomogram combining CT-based handcrafted radiomics and deep learning (DL) features to preoperatively predict muscle invasion in bladder cancer (BCa) with multi-center validation. Methods In this retrospective study, 323 patients underwent radical cystectomy with pathologically confirmed BCa were enrolled and randomly divided into the training cohort (n = 226) and internal validation cohort (n = 97). And fifty-two patients from another independent medical center were enrolled as an independent external validation cohort. Handcrafted radiomics and DL features were constructed from preoperative nephrographic phase CT images. Least absolute shrinkage and selection operator (LASSO) regression was used to identify the most discriminative features in train cohort. Multivariate logistic regression was used to develop the predictive model and a deep learning radiomics nomogram (DLRN) was constructed. The predictive performance of models was evaluated by area under the curves (AUC) in the three cohorts. The calibration and clinical usefulness of DLRN were estimated by calibration curve and decision curve analysis. Results The nomogram that incorporated radiomics signature and DL signature demonstrated satisfactory predictive performance for differentiating non-muscle invasive bladder cancer (NMIBC) from muscle invasive bladder cancer (MIBC), with an AUC of 0.884 (95 % CI: 0.813-0.953) in internal validation cohort and 0.862 (95 % CI: 0.756-0.968) in external validation cohort, respectively. Decision curve analysis confirmed the clinical usefulness of the nomogram. Conclusions A CT-based deep learning radiomics nomogram exhibited a promising performance for preoperative prediction of muscle invasion in bladder cancer, and may be helpful in the clinical decision-making process.
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Affiliation(s)
- Zongjie Wei
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huayun Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingjie Xv
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fangtong Liao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quanhao He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongpeng Xie
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Gong Y, Cheng Y, Zhang J, Bao ML, Zhu FP, Sun XY, Zhang YD. Role of Additional MRI-Based Morphologic Measurements on the Performance of VI-RADS for Muscle-Invasive Bladder Cancer. J Magn Reson Imaging 2024. [PMID: 38258496 DOI: 10.1002/jmri.29184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Vesical Imaging-Reporting and Data System (VI-RADS) is a pathway for the standardized imaging and reporting of bladder cancer staging using multiparametric (mp) MRI. PURPOSE To investigate additional role of morphological (MOR) measurements to VI-RADS for the detection of muscle-invasive bladder cancer (MIBC) with mpMRI. STUDY TYPE Retrospective. POPULATION A total of 198 patients (72 MIBC and 126 NMIBC) underwent bladder mpMRI was included. FIELD STRENGTH/SEQUENCE 3.0 T/T2-weighted imaging with fast-spin-echo sequence, spin-echo-planar diffusion-weighted imaging and dynamic contrast-enhanced imaging with fast 3D gradient-echo sequence. ASSESSMENT VI-RADS score and MOR measurement including tumor location, number, stalk, cauliflower-like surface, type of tumor growth, tumor-muscle contact margin (TCM), tumor-longitudinal length (TLL), and tumor cellularity index (TCI) were analyzed by three uroradiologists (3-year, 8-year, and 15-year experience of bladder MRI, respectively) who were blinded to histopathology. STATISTICAL TESTS Significant MOR measurements associated with MIBC were tested by univariable and multivariable logistic regression (LR) analysis with odds ratio (OR). Area under receiver operating characteristic curve (AUC) with DeLong's test and decision curve analysis (DCA) were used to compared the performance of unadjusted vs. adjusted VI-RADS. A P-value <0.05 was considered statistically significant. RESULTS TCM (OR 9.98; 95% confidence interval [CI] 4.77-20.8), TCI (OR 5.72; 95% CI 2.37-13.8), and TLL (OR 3.35; 95% CI 1.40-8.03) were independently associated with MIBC at multivariable LR analysis. VI-RADS adjusted by three MORs achieved significantly higher AUC (reader 1 0.908 vs. 0.798; reader 2 0.906 vs. 0.855; reader 3 0.907 vs. 0.831) and better clinical benefits than unadjusted VI-RADS at DCA. Specially in VI-RADS-defined equivocal lesions, MOR-based adjustment resulted in 55.5% (25/45), 70.4% (38/54), and 46.4% (26/56) improvement in accuracy for discriminating MIBC in three readers, respectively. DATA CONCLUSION MOR measurements improved the performance of VI-RADS in detecting MIBC with mpMRI, especially for equivocal lesions. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yu Gong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Cheng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei-Ling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Peng Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue-Ying Sun
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Messina E, Proietti F, Laschena L, Flammia RS, Pecoraro M, Cipollari S, Simone G, Catalano C, Leonardo C, Panebianco V. MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study. Eur Radiol Exp 2024; 8:9. [PMID: 38238523 PMCID: PMC10796856 DOI: 10.1186/s41747-023-00403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/03/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is recommended in patients with upper tract urothelial carcinoma (UTUC) only when computed tomography (CT) is contraindicated. However, CT does not allow distinguishing ureter wall layers, making impossible to assess muscle invasion, a factor contributing to differentiate high- from low-risk UTUCs, which require different therapeutic approaches. We investigated the feasibility of MRI assessment of UTUC muscle invasion. METHODS From June 2022 to March 2023, we prospectively enrolled patients suspected of UTUC, i.e., with positive urinary tract ultrasound and/or ureteroscopy, or positive urinary cytology and/or hematuria but negative cystoscopy and bladder ultrasound at two Italian centers. They underwent CT followed by MRI (≤ 24 h apart), independently reported by two experienced radiologists, blinded from histopathology results. After imaging confirmation, they all underwent nephroureterectomy and histopathology analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS Thirty-nine lesions were detected in 30 patients on both CT and MRI. Muscle-invasive UTUC prevalence was 81% (21/26) among patients with MRI suspicion and 8% (1/13) among those without MRI suspicion (p < 0.001). Considering the assessment of muscle-layer invasion, the more experienced reader achieved 95% sensitivity (95% confidence interval 82-100), 71% specificity (47-88), 81% PPV (63-93), 92% NPV (70-100), 85% accuracy (67-96), and 0.84 AUC (0.70-0.98). Inter-reader agreement was substantial (κ = 0.73). CONCLUSIONS MRI showed a promising diagnostic performance for the assessment of UTUC risk of muscle invasion. RELEVANCE STATEMENT Resulting feasible both in technical and clinical terms, MRI could be helpful for upper tract urothelial carcinomas pre-operative risk stratification, to allow a personalized patients' management. These results play in favor of promoting preoperative MRI for UTUC, as already proven for bladder cancer. KEY POINTS • Muscle invasion is a crucial information for tailored treatments of upper tract urothelial carcinomas. • CT does not distinguish ureter wall layers, making muscle invasion risk assessment not feasible. • MRI was shown to reliably diagnose muscle-layer invasion by upper tract urothelial carcinomas (sensitivity 95%, specificity 71%).
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Affiliation(s)
- Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Flavia Proietti
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Ludovica Laschena
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy.
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, Rome, 00161, Italy.
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Ren Y, Wang G, Wang P, Liu K, Liu Q, Sun H, Li X, Wei B. MM-SFENet: multi-scale multi-task localization and classification of bladder cancer in MRI with spatial feature encoder network. Phys Med Biol 2024; 69:025009. [PMID: 38091612 DOI: 10.1088/1361-6560/ad1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
Objective. Bladder cancer is a common malignant urinary carcinoma, with muscle-invasive and non-muscle-invasive as its two major subtypes. This paper aims to achieve automated bladder cancer invasiveness localization and classification based on MRI.Approach. Different from previous efforts that segment bladder wall and tumor, we propose a novel end-to-end multi-scale multi-task spatial feature encoder network (MM-SFENet) for locating and classifying bladder cancer, according to the classification criteria of the spatial relationship between the tumor and bladder wall. First, we built a backbone with residual blocks to distinguish bladder wall and tumor; then, a spatial feature encoder is designed to encode the multi-level features of the backbone to learn the criteria.Main Results. We substitute Smooth-L1 Loss with IoU Loss for multi-task learning, to improve the accuracy of the classification task. By learning two datasets collected from bladder cancer patients at the hospital, the mAP, IoU, Acc, Sen and Spec are used as the evaluation metrics. The experimental result could reach 93.34%, 83.16%, 85.65%, 81.51%, 89.23% on test set1 and 80.21%, 75.43%, 79.52%, 71.87%, 77.86% on test set2.Significance. The experimental result demonstrates the effectiveness of the proposed MM-SFENet on the localization and classification of bladder cancer. It may provide an effective supplementary diagnosis method for bladder cancer staging.
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Affiliation(s)
- Yu Ren
- College of Electronic Engineering and Intelligent Manufacturing, Anqing Normal University, Anqing 246133, People's Republic of China
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
| | - Guoli Wang
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
| | - Pingping Wang
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
| | - Kunmeng Liu
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
| | - Quanjin Liu
- College of Electronic Engineering and Intelligent Manufacturing, Anqing Normal University, Anqing 246133, People's Republic of China
| | - Hongfu Sun
- Urological department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, People's Republic of China
| | - Xiang Li
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
| | - Bengzheng Wei
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao 266112, People's Republic of China
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Li X. Editorial for "Significance of Normalized Apparent Diffusion Coefficient in the Vesical Imaging-Reporting and Data System for Diagnosing Muscle-Invasive Bladder Cancer". J Magn Reson Imaging 2024. [PMID: 38197293 DOI: 10.1002/jmri.29233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Xiufeng Li
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
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Bahlburg H, Roghmann F. [Overall survival and cancer-specific mortality in patients with very high-risk non-muscle-invasive bladder cancer (NMIBC) : Retrospective analysis of a US American single-center cohort]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:100-101. [PMID: 38127146 DOI: 10.1007/s00120-023-02252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Henning Bahlburg
- Klinik für Urologie und Neuro-Urologie, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - Florian Roghmann
- Klinik für Urologie und Neuro-Urologie, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
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Alfred Witjes J, Max Bruins H, Carrión A, Cathomas R, Compérat E, Efstathiou JA, Fietkau R, Gakis G, Lorch A, Martini A, Mertens LS, Meijer RP, Milowsky MI, Neuzillet Y, Panebianco V, Redlef J, Rink M, Rouanne M, Thalmann GN, Sæbjørnsen S, Veskimäe E, van der Heijden AG. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol 2024; 85:17-31. [PMID: 37858453 DOI: 10.1016/j.eururo.2023.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
CONTEXT We present an overview of the updated 2023 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). OBJECTIVE To provide practical evidence-based recommendations and consensus statements on the clinical management of MMIBC with a focus on diagnosis and treatment. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the MMIBC guidelines has been performed annually since 2017. Searches cover the Medline, EMBASE, and Cochrane Libraries databases for yearly guideline updates. A level of evidence and strength of recommendation are assigned. The evidence cutoff date for the 2023 MIBC guidelines was May 4, 2022. EVIDENCE SYNTHESIS Patients should be counselled regarding risk factors for bladder cancer. Pathologists should describe tumour and lymph nodes in detail, including the presence of histological subtypes. The importance of the presence or absence of urothelial carcinoma (UC) in the prostatic urethra is emphasised. Magnetic resonance imaging (MRI) of the bladder is superior to computed tomography (CT) for disease staging, specifically in differentiating T1 from T2 disease, and may lead to a change in treatment approach in patients at high risk of an invasive tumour. Imaging of the upper urinary tract, lymph nodes, and distant metastasis is performed with CT or MRI; the additional value of flurodeoxyglucose positron emission tomography/CT still needs to be determined. Frail and comorbid patients should be evaluated by a multidisciplinary team. Postoperative histology remains the most important prognostic variable, while circulating tumour DNA appears to be an interesting predictive marker. Neoadjuvant systemic therapy remains cisplatin-based. In motivated and selected women and men, sexual organ-preserving cystectomy results in better functional outcomes without compromising oncological outcomes. Robotic and open cystectomy have comparable outcomes and should be combined with (extended) lymph node dissection. The diversion type is an individual choice after taking patient and tumour characteristics into account. Radical cystectomy remains a highly complex procedure with considerable morbidity and risk of mortality, although lower rates are observed for higher hospital volumes (>20 cases/yr). With proper patient selection, trimodal therapy (chemoradiation) has comparable outcomes to radical cystectomy. Adjuvant chemotherapy after surgery improves disease-specific survival and overall survival (OS) in patients with high-risk disease who did not receive neoadjuvant treatment, and is strongly recommended. There is a weak recommendation for adjuvant nivolumab, as OS data are not yet available. Health-related quality of life should be assessed using validated questionnaires at baseline and after treatment. Surveillance is needed to monitor for recurrent cancer and functional outcomes. Recurrences detected on follow-up seem to have better prognosis than symptomatic recurrences. CONCLUSIONS This summary of the 2023 EAU guidelines provides updated information on the diagnosis and treatment of MMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology guidelines panel on muscle-invasive and metastatic bladder cancer has released an updated version of the guideline containing information on diagnosis and treatment of this disease. Recommendations are based on studies published up to May 4, 2022. Surgical removal of the bladder and bladder preservation are discussed, as well as updates on the use of chemotherapy and immunotherapy in localised and metastatic disease.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Harman Max Bruins
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Albert Carrión
- Department of Urology, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Richard Cathomas
- Department of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Eva Compérat
- Department of Pathology, Medical University Vienna General Hospital, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Rainer Fietkau
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Alberto Martini
- Department of Urology, Institut Universitaire du Cancer-Toulouse-Oncopole, Toulouse, France; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - John Redlef
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Michael Rink
- Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Mathieu Rouanne
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - George N Thalmann
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sæbjørn Sæbjørnsen
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Kang KA, Kim MJ, Kwon GY, Kim CK, Park SY. Computed tomography-based prediction model for identifying patients with high probability of non-muscle-invasive bladder cancer. Abdom Radiol (NY) 2024; 49:163-172. [PMID: 37848639 DOI: 10.1007/s00261-023-04069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To investigate computed tomography (CT)-based prediction model for identifying patients with high probability of non-muscle-invasive bladder cancer (NMIBC). METHODS This retrospective study evaluated 147 consecutive patients who underwent contrast-enhanced CT and surgery for bladder cancer. Using corticomedullary-to-portal venous phase images, two independent readers analyzed bladder muscle invasion, tumor stalk, and tumor size, respectively. Three-point scale (i.e., from 0 to 2) was applied for assessing the suspicion degree of muscle invasion or tumor stalk. A multivariate prediction model using the CT parameters for achieving high positive predictive value (PPV) for NMIBC was investigated. The PPVs from raw data or 1000 bootstrap resampling and inter-reader agreement using Gwet's AC1 were analyzed, respectively. RESULTS Proportion of patients with NMIBC was 81.0% (119/147). The CT criteria of the prediction model were as follows: (a) muscle invasion score < 2; (b) tumor stalk score > 0; and (c) tumor size < 3 cm. From the raw data, PPV of the model for NMIBC was 92.7% (51/55; 95% confidence interval [CI] 82.4-98.0) in reader 1 and 93.3% (42/45; 95% CI 81.7-98.6) in reader 2. From the bootstrap data, PPV was 92.8% (95% CI 85.2-98.3) in reader 1 and 93.4% (95% CI 84.9-99.9) in reader 2. The model's AC1 was 0.753 (95% CI 0.647-0.859). CONCLUSION The current CT-derived prediction model demonstrated high PPV for identifying patients with NMIBC. Depending on CT findings, approximately 30% of patients with bladder cancer may have a low need for additional MRI for interpreting vesical imaging-reporting and data system.
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Affiliation(s)
- Kyung A Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Min Je Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Urso L, Bauckneht M, Albano D, Chondrogiannis S, Grassetto G, Lanfranchi F, Dondi F, Fornarini G, Lazzeri M, Evangelista L. The evolution of PET imaging in renal, bladder, upper urinary tract urothelial, testicular and penile carcinoma - Today's impact, tomorrow's potential. Expert Rev Med Devices 2024; 21:55-72. [PMID: 38072680 DOI: 10.1080/17434440.2023.2293919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/07/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The advancement of hybrid PET/CT or PET/MRI imaging for non-prostate genitourinary cancers has not experienced the rapid progress of prostate cancer. Nevertheless, these neoplasms are aggressive and reliable imaging plays a pivotal role in enhancing patients' quality of life and prognosis. AREAS COVERED the main evidence regarding [18F]FDG and non-[18F]FDG PET/CT or PET/MRI in non-prostate uro-oncological malignancies are summarized and discussed. Moreover, potential future directions concerning PET imaging in these neoplasms are debated, with the aim to stimulate future research projects covering these fields. EXPERT OPINION In Renal Cell Carcinoma (RCC), [18F]FDG PET/CT demonstrates varying efficacy in staging, restaging, and prognostic stratification, but PSMA PET/CT is emerging as a potential game-changer, particularly in advanced, high-grade aggressive clear cell RCC. [18F]FDG PET/CT may see an increased use in N and M-staging of bladder cancer, as well as for detecting recurrence and response to neoadjuvant chemotherapy. Preliminary data regarding [68Ga]-FAPI also looks promising in this context. [18F]FDG PET/MRI could be useful for the T-staging of bladder cancer, while upper tract urothelial carcinoma still lacks of molecular imaging literature reports. In testicular and penile cancer [18F]FDG PET/CT has demonstrated its usefulness in several clinical settings, although experiences with non-[18F]FDG radiotracers are lacking.
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Affiliation(s)
- Luca Urso
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Domenico Albano
- Nuclear Medicine Department, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Sotirios Chondrogiannis
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gaia Grassetto
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Francesco Lanfranchi
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Francesco Dondi
- Nuclear Medicine Department, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Arita Y, Kwee TC, Woo S, Shigeta K, Ishii R, Okawara N, Edo H, Waseda Y, Vargas HA. Biparametric versus Multiparametric Magnetic Resonance Imaging for Assessing Muscle Invasion in Bladder Urothelial Carcinoma with Variant Histology Using the Vesical Imaging-Reporting and Data System. Eur Urol Focus 2024; 10:131-138. [PMID: 37633790 DOI: 10.1016/j.euf.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The diagnostic performance of contrast medium-free biparametric magnetic resonance imaging (bpMRI; combining T2-weighted imaging [T2WI] and diffusion-weighted imaging [DWI]) for evaluating variant-histology urothelial carcinoma (VUC) remains unknown. OBJECTIVE To compare the diagnostic performance of bpMRI and multiparametric MRI (mpMRI; combining T2WI, DWI, and dynamic contrast-enhanced MRI]) for assessing muscle invasion of VUC. DESIGN, SETTING, AND PARTICIPANTS This multi-institution retrospective analysis included 118 patients with pathologically verified VUC who underwent bladder mpMRI before transurethral bladder tumor resection between 2010 and 2019. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three board-certified radiologists separately evaluated two sets of images, set 1 (bpMRI) and set 2 (mpMRI), in accordance with the Vesical Imaging Reporting and Data System (VI-RADS). The histopathology results were utilized as a reference standard. Receiver operating characteristic curve analysis, Z test, and Wald test were used to assess diagnostic abilities. RESULTS AND LIMITATIONS Sixty-six (55.9%) and 52 (44.1%) of the 118 patients with VUC included in the analysis (mean age, 71 ± 10 yr; 88 men) had muscle-invasive bladder cancer (MIBC) and non-MIBC, respectively. For the diagnosis of MIBC, the areas under the curve for bpMRI were significantly smaller than those for mpMRI (0.870-0.884 vs 0.902-0.923, p < 0.05). The sensitivity of bpMRI was significantly lower than that of mpMRI for all readers with a VI-RADS cutoff score of 4 (65.2-66.7% vs 77.3-80.3%, p < 0.05). The specificity of bpMRI and mpMRI did not differ significantly for all readers (88.5-90.4 vs 88.5-92.3, p > 0.05). A limitation of the study is the limited sample size because of the rarity of VUC. CONCLUSIONS In patients with VUC, on applying VI-RADS, the diagnostic results of bpMRI were inferior to those of mpMRI for evaluating muscle invasion. Therefore, mpMRI-based methods are recommended for evaluating muscle invasiveness of VUC. PATIENT SUMMARY Contrast medium-free biparametric magnetic resonance imaging (bpMRI)-based Vesical Imaging Reporting and Data System (VI-RADS) can accurately diagnose pure urothelial carcinomas, similar to conventional multiparametric magnetic resonance imaging-based VI-RADS. However, bpMRI-based VI-RADS may misdiagnose muscle invasiveness of urothelial carcinoma with variant histology, particularly when its cutoff score is 4.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoko Okawara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromi Edo
- Department of Radiology, National Defence Medical College, Saitama, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Liu P, Cai L, Yu R, Cao Q, Bai K, Zhuang J, Wu Q, Li P, Yang X, Lu Q. Significance of Normalized Apparent Diffusion Coefficient in the Vesical Imaging-Reporting and Data System for Diagnosing Muscle-Invasive Bladder Cancer. J Magn Reson Imaging 2023. [PMID: 38153874 DOI: 10.1002/jmri.29208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Vesical Imaging-Reporting and Data System (VI-RADS) has been developed for assessing bladder cancer from multiparametric (mp) MRI but its performance in diagnosing muscle-invasive bladder cancer (MIBC) is suboptimal. PURPOSE To investigate associations between normalized apparent diffusion coefficient (NADC) and clinicopathological characteristics and to determine whether the inclusion of NADC can improve the performance of VI-RADS in diagnosing MIBC. STUDY TYPE Retrospective. POPULATION Two hundred seventy-five patients with pathologically confirmed bladder cancer (101 MIBC and 174 non-MIBC [NMIBC]) underwent preoperative mpMRI (233 male, 42 female). FIELD STRENGTH/SEQUENCE 3-T, T2-weighted imaging (turbo spin-echo), diffusion-weighted imaging (free-breathing spin-echo), and dynamic contrast-enhanced imaging (gradient-echo). ASSESSMENT NADC was the mean ADC of tumor divided by that of the iliopsoas muscles in trans caput femoris plane. Associations between NADC and clinicopathological characteristics were evaluated. Models were established for differentiating MIBC and NMIBC: VI-RADS model; VN model (VI-RADS and NADC), Images model (significant variables from imaging associated with MIBC), LN model (Images model without NADC), and Full model (all significant variables associated with MIBC). STATISTICAL TESTS Variables for model development were based on logistic regression. Models were evaluated by receiver operating characteristic (ROC) curve. Comparison of the area under the curves (AUCs) for the models used DeLong's test. A P value <0.05 was considered statistically significant. RESULTS NADC was significantly lower in lesions with diameter ≥ 3 cm, MIBC, histological high grade, lymph node metastasis, and lymphovascular invasion. Compared with VI-RADS model, the AUCs for VN model (VI-RADS score and NADC), Images model (VI-RADS score, NADC and tumor size) and Full model (VI-RADS score, NADC, tumor size and histological grade) were significantly higher. No significant differences were observed between the AUCs for VN model and Images model (P = 0.051). DATA CONCLUSION NADC reflects information about the aggressiveness of bladder cancer. Combining VI-RADS with NADC can improve performance in diagnosing MIBC. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Peikun Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruixi Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kexin Bai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhuang J, Cai L, Sun H, Wu Q, Li K, Yu R, Cao Q, Li P, Yang X, Lu Q. Vesical imaging reporting and data system (VI-RADS) could predict the survival of bladder-cancer patients who received radical cystectomy. Sci Rep 2023; 13:21502. [PMID: 38057353 PMCID: PMC10700510 DOI: 10.1038/s41598-023-48840-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Vesical Imaging Reporting and Data System (VI-RADS) shows good potential in determining muscle-invasive bladder cancer (MIBC) patients. However, whether VI-RADS could predict the prognosis of radical cystectomy (RC) patients has not been reported. Our purpose is to determine whether VI-RADS contributed to predict oncologic outcomes. In this retrospective study, we analysed the information of bladder cancer patients who admitted to our centre from June 2012 to June 2022. All patients who underwent multiparametric magnetic resonance imaging (mpMRI) and underwent RC were included. VI-RADS scoring was performed by two radiologists blinded to the clinical data. Patients' clinical features, pathology data, and imaging information were recorded. Kaplan-Meier method was used to estimate patients' overall survival (OS) and progression-free survival (PFS). Log-rank test was used to assess statistical differences. COX regression analysis was used to estimate risk factors. Ultimately, we included 219 patients, with 188 males and 31 females. The median age was 66 (IQR = 61-74.5) years. The VI-RADS scores were as follows: VI-RADS 1, 4 (1.8%); VI-RADS 2, 68 (31.1%); VI-RADS 3, 40 (18.3%); VI-RADS 4, 69 (31.5%); and VI-RADS 5, 38 (17.4%). Patients with VI-RADS ≥ 3 had poorer OS and PFS than those with VI-RADS < 3. The AUC of VI-RADS predicting 3-year OS was 0.804, with sensitivity of 0.824 and negative predictive value of 0.942. Multivariate COX analysis showed that VI-RADS ≥ 3 was risk factors for OS (HR = 3.517, P = 0.003) and PFS (HR = 4.175, P < 0.001). In the MIBC subgroup, patients with VI-RADS ≥ 4 had poorer OS and PFS. In the non-muscle invasive bladder cancer (NMIBC) subgroup, the prognosis of patients with VI-RADS ≥ 3 remained poorer. VI-RADS scores could effectively predict the survival of patients after RC.
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Affiliation(s)
- Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Huanyou Sun
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruixi Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Jazayeri SB, Dehghanbanadaki H, Hosseini M, Taghipour P, Bacchus MW, Di Valerio EA, Sarabchian E, Balaji K, Bandyk M. Can magnetic resonance imaging differentiate muscle invasion (T2) and lamina propria invasion (T1) urothelial carcinoma of the bladder? A systematic review and meta-analysis of Vesical Imaging-Reporting and Data System accuracy. Curr Urol 2023; 17:262-267. [PMID: 37994331 PMCID: PMC10662806 DOI: 10.1097/cu9.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/04/2022] [Indexed: 11/24/2023] Open
Abstract
Background Vesical Imaging-Reporting and Data System (VI-RADS) was developed as a structured reporting tool to anticipate the possibility of muscle invasion. This study is aimed to investigate the diagnostic accuracy of VI-RADS for discriminating T2 from T1 bladder cancer. Materials and methods Scopus, Web of Science, PubMed, and Embase were searched on October 4, 2021, for studies with the following characteristics: (1) bladder cancer patient population, (2) VI-RADS as an index test, (3) retransurethral resection of bladder tumor/cystectomy as a reference, and (4) adequate VI-RADS score data for T1 and T2 lesions. The analyses were performed using the binary regression model of MIDAS in Stata. Results Six studies with 624 magnetic resonance imaging reports were included. The receiver operating characteristics curve for differentiation of T2 from T1 bladder cancer showed an area under the curve of 0.93 (95% confidence interval [CI], 0.91-0.95) for a VI-RADS ≥3 and 0.75 (95% CI, 0.71-0.79) for a VI-RADS ≥4. A VI-RADS ≥3 showed high sensitivity of 93% (95% CI, 85%-97%), specificity of 61% (95% CI, 30%-86%), positive likelihood ratio of 2.4 (95% CI, 1.1-5.3), and negative likelihood ratio of 0.11 (95% CI, 0.05-0.24). A total of 10.4% of T2 lesions were scored as VI-RADS 2, while 10% of T1 lesions were scored as VI-RADS 4 or 5. Conclusions The VI-RADS ≥3 has high accuracy and sensitivity for detecting muscle invasion in borderline populations of T1 or T2 bladder cancer. Thus, the VI-RADS could be a good non-invasive screening test for the detection of T2 urothelial lesions.
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Affiliation(s)
- Seyed Behzad Jazayeri
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Hojat Dehghanbanadaki
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mahdie Hosseini
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Pourya Taghipour
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael W. Bacchus
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Elnaz Sarabchian
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - K.C. Balaji
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mark Bandyk
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
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Kazan O, Gunduz N, Bakir B, Iplikci A, Culpan M, Ersoy B, Yildirim A. Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): a real-world study. Actas Urol Esp 2023; 47:638-644. [PMID: 37209783 DOI: 10.1016/j.acuroe.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting. METHODS Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed. RESULTS Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS ≥3 and ≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS ≥3 and ≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (κ = 0.45). CONCLUSION VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate.
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Affiliation(s)
- O Kazan
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey.
| | - N Gunduz
- Servicio de Radiología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - B Bakir
- Servicio de Radiología, Universidad de Estambul, Escuela de Medicina de Estambul, Estambul, Turkey
| | - A Iplikci
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - M Culpan
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - B Ersoy
- Servicio de Radiología, Universidad de Estambul, Escuela de Medicina de Estambul, Estambul, Turkey
| | - A Yildirim
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
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