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Combining Volumetric ADC Histogram Analysis with Vesical Imaging Reporting and Data System to Predict the Muscle Invasion of Bladder Cancer
Shichao Li1, Ping Liang1, Yanchun Wang1, Yaqi Shen1, Xuemei Hu1, Daoyu Hu1, Xiaoyan Meng1, and Zhen Li1
1Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Synopsis

This study explored the clinical value of volumetric apparent diffusion coefficient (ADC) histogram analysis and Vesical Imaging Reporting and Data System (VI-RADS) in differentiating muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC), and demonstrated that both are helpful and the volumetric ADC histogram can provide additional value to VI-RADS.

Aim

The objective of this study was to explore whether volumetric apparent diffusion coefficient (ADC) histogram analysis can provide additional value to Vesical Imaging Reporting and Data System (VI-RADS) in differentiating muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC).

Materials and Methods

88 patients were retrospectively reviewed with pathologically proven NMIBC (n=61) or MIBC (n=27). All patients were performed MRI examinations including diffusion-weighted imaging (DWI) (b=0, 800s/mm2), and the VI-RADS score was evaluated based on DWI. Volumetric ADC histogram parameters were calculated from the volumetric of interest (VOI) on DWI, including the min ADC, mean ADC, median ADC, max ADC, 10th, 25th, 75th, 90th percentiles ADC, skewness, kurtosis, and entropy. The Mann-Whitney U-test was used to compare histogram parameters between NMIBC and MIBC. Receiver operating characteristic curves analysis was used to evaluate the diagnostic value of each significant parameter.

Results

Among all parameters, the VI-RADS had the highest AUC (AUC, 0.88; sensitivity, 88.89%; specificity, 83.61%). MIBC had significantly lower min ADC, mean ADC, median ADC, 10th, 25th, 75th, 90th percentiles ADC than NMIBC (p=0.002, p<0.001, p<0.001, p=0.003, p=0.004, p<0.001, p<0.001). Skewness and kurtosis of MIBC were significantly higher than that of NMIBC (p<0.001, p<0.001). The combination of VI-RADS and skewness showed significantly higher AUC (AUC:0.923, 95% CI: 0.847-0.969) than only with VI-RADS (AUC,0.880, 95% CI: 0.793-0.940).

Cobclusion

Volumetric ADC histogram analysis and VI-RADS are both useful methods in differentiating MIBC from NMIBC, and the Volumetric ADC histogram analysis could provide additional value to VI-RADS.

Acknowledgements

This study is supported by the grants from National Natural Science Foundation of China (NSFC) No. 81771801，82071889, 81801695 and 81701657，82071890.

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Figures

FIgure 1. Non-muscle-invasive papillary urothelial carcinoma in the anterior bladder wall in a 56-year-old-man. a. Axial T2-weighted image; b. Axial DWI images; c. Corresponding diffusion-weighted image reconstruction of ADC values (ADC values are given in units of ×10-3 mm2/s). d. Volumetric ADC histogram shows a large portion of voxels with high ADC values and positive skewness of 0.725 and negative kurtosis of 0.018.

Figure 2. Muscle-invasive papillary urothelial carcinoma in the posterior bladder wall in a 71-year-old-man. a. Axial T2-weighted image; b. Axial DWI images; c. Corresponding diffusion-weighted image reconstruction of ADC values (ADC values are given in units of ×10-3 mm2/s). d. Volumetric ADC histogram shows a large portion of voxels with low ADC values and positive skewness of 2.993 and positive kurtosis of 11.225.

Figure 3: Boxplots show median and interquartile ranges for the histogram parameters for (a) ADCmin, ADC10%, ADC25%, ADCmedian, ADCmean, ADC75%, ADC90%, and (b) kurtosis and skewness between NMIBC and MIBC. The ADCmin, ADC10%, ADC25%, ADCmedian, ADCmean, ADC75% and ADC90% were significantly lower in the MIBC group than in the NMIBC group.

Figure 4: ROC curves of VI-RADS score and volumetric ADC histogram parameters

Figure 5. ROC curves of VI-RADS score combined with volumetric ADC histogram parameters

Proc. Intl. Soc. Mag. Reson. Med. 29 (2021)
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