Nonmuscle-invasive and Muscle-invasive Urinary Bladder Cancer: Image Quality and Clinical Value of Reduced Field-of-view Versus Conventional Single-shot Echo-planar Imaging DWI

Yanchun Wang, Zhen Li, Xiaoyan Meng, Xuemei Hu, Yaqi Shen, John Morelli, Hui Lin, Zhongping Zhang, Daoyu Hu, Yanchun Wang, Zhen Li, Xiaoyan Meng, Xuemei Hu, Yaqi Shen, John Morelli, Hui Lin, Zhongping Zhang, Daoyu Hu

Abstract

This study compared the imaging quality, diagnostic accuracy, and apparent diffusion coefficient (ADC) values of reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) and full field-of-view (fFOV) single-shot echo-planar imaging with regard to patients with nonmuscle-invasive or muscle-invasive bladder cancer.Thirty-nine patients with 60 bladder tumors underwent rFOV and fFOV DWI in this internal review board-approved study. Pathologic and histologic grades were determined for all tumors. Two observers rated DWI image quality using a 4-point scale. Two radiologists who were blinded to the pathology findings reviewed 3 image sets (T2-weighted alone, T2-weighted plus fFOV DWI, and T2-weighted plus rFOV DWI) and assigned T stages and confidence levels for tumors of stage T2 or higher. The image quality scores for the 2 DWI sequences were assessed using the Wilcoxon signed-rank test. Differences in the diagnostic accuracy, sensitivity, and specificity for each image set were evaluated using the McNemar test. Differences in performance were analyzed by comparing the areas under the receiver-operating characteristic curves (ie, the Az values). A Mann-Whitney U test was used to compare the mean ADCs and the relationship between tumor stage and histologic grade.Image quality scores were significantly higher for rFOV (mean = 3.62) than for fFOV DWI (2.98; P < 0.001). The pooled diagnostic accuracies were 57%, 70%, and 78% for the T2-weighted alone images, the T2-weighted plus fFOV DWI images, and the T2-weighted plus rFOV DWI images, respectively. The overall accuracy, specificity, and Az for diagnosing T2 or higher stages were significantly improved by adding rFOV DWI (P < 0.05). The mean ADC values of the muscle-invasive and G3 grade bladder cancers were significantly lower than those of the nonmuscle-invasive tumors and G1 grade cancers, regardless of DWI sequence (P < 0.01).rFOV DWI is superior to fFOV DWI with respect to image quality and diagnostic accuracy. ADC values might be useful for distinguishing nonmuscle-invasive from muscle-invasive cancers, and G1 from G3 grade lesions.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram demonstrating patient and tumor characteristics.
FIGURE 2
FIGURE 2
A 64-year-old man with stage pT1 papillary urothelial carcinoma. A, B, The axial fFOV DW MRI shows a severe magnetic susceptibility artifact at the junction of the bladder and rectum (arrow). C, D, The axial rFOV DW MRI demonstrates a significantly reduced artifact in this location (arrow). DW = diffusion-weighted, fFOV = full field of view, MRI = magnetic resonance imaging, rFOV = reduced field of view.
FIGURE 3
FIGURE 3
A 69-year-old man with multiple stages of pT1 papillary urothelial carcinoma. A, The T2-weighted imaging shows tumor tissue with intermediate SI within the posterior urinary bladder. The SI of the muscle layer at the base of the tumor is slightly elevated (arrow). B, The axial fFOV DW MRI shows a C-shaped high-SI area with a low-SI stalk connected to the posterior side of the bladder wall (arrow). C, The axial rFOV DW MRI shows the tumor and stalk more clearly (arrow). D, The corresponding specimen obtained on radical cystectomy shows a papillary tumor tissue (star) with a submucosal stalk (arrow). E, The photomicrograph of the specimen shows papillary cancer (T) with a submucosal stalk (star); hematoxylin and eosin stain; original magnification, ×100. DW = diffusion-weighted, fFOV = full field of view, MRI = magnetic resonance imaging, rFOV = reduced field of view, SI = signal intensity.
FIGURE 4
FIGURE 4
A 51-year-old man with multiple stages of pT1 urothelial carcinoma (A–C) and a 70-year-old man with stages of pT1 papillary urothelial carcinoma (D–F). A, D, The axial T2-weighted MRI shows elongated oval masses along the right bladder wall (arrow) and the left lateral wall (arrow and open arrow). The SI of the muscle layer at the base of the 3 tumors is slightly elevated, and the low SI line was disrupted. B, E, The axial fFOV DW MRI shows 2 high SI tumors without a submucosal stalk, but with a smooth tumor margin and submucosal thickening (arrow and open arrow). C, F, The axial rFOV DW MRI shows the 2 high SI tumors with a thickened submucosa (arrow and open arrow). DW = diffusion-weighted, fFOV = full field of view, MRI = magnetic resonance imaging, rFOV = reduced field of view.
FIGURE 5
FIGURE 5
A 51-year-old man with stages of pT2b urothelial carcinoma. A, The axial T2-weighted MRI shows an ovoid mass along the right urinary bladder wall. The tumor extends into the perivesical fat with an irregular contour (arrow). B, The axial fFOV DW MRI shows a bulging tumor with a smooth margin on the right wall of the bladder. C, The axial rFOV DW MRI shows a bulging tumor with a smooth margin on right wall of the bladder more clearly. DW = diffusion-weighted, fFOV = full field of view, MRI = magnetic resonance imaging, rFOV = reduced field of view.

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