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目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值在膀胱癌术后随访中的应用价值。资料与方法膀胱癌术后可疑复发患者44例,于3.0 TMRI上行常规平扫增强及DWI检查。比较增强序列与DWI鉴别膀胱癌复发及炎症的能力。采用配对t检验比较膀胱癌复发与炎症的ADC值区别,并绘制ADC值诊断膀胱癌复发的受试者工作特征(ROC)曲线。结果增强序列诊断膀胱癌复发的准确性、敏感性及特异性分别为79.5%、96%、57.9%;DWI为95.5%、96%、94.7%。DWI诊断结果与病理一致性相当好(Kappa=0.907),增强序列一致性中等(Kappa=0.564)。DWI与病理诊断结果的McNemar检验无显著差异(P>0.05),增强序列与病理诊断结果有显著差异(P<0.05)。膀胱癌复发的平均ADC值为(0.90±0.23)×10-3mm2/s,显著低于炎症(1.32±0.14)×10-3mm2/s。ADC值鉴别膀胱癌复发与炎症的准确率高(ROC曲线下面积=0.93),ADC值取1.075×10-3mm2/s时是最佳诊断界值(敏感性+特异性=1.833)。结论 DWI序列对膀胱癌术后鉴别肿瘤复发及炎症瘢痕有重要价值,应作为膀胱MR检查的常规序列。
Objective To investigate the value of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values in the postoperative follow-up of bladder cancer. Materials and Methods Forty-four patients with suspicious recurrent bladder cancer were examined by conventional T-scan with enhanced MRI and DWI. Comparison of enhanced sequences and DWI to identify bladder cancer recurrence and inflammation. The paired t-test was used to compare the ADC value of bladder cancer recurrence and inflammation, and the ADC value was plotted to determine the receiver operating characteristic (ROC) curve of bladder cancer recurrence. Results The accuracy, sensitivity and specificity of enhanced sequence in diagnosis of bladder cancer recurrence were 79.5%, 96% and 57.9%, respectively. The DWI was 95.5%, 96% and 94.7% respectively. The DWI diagnostic results were fairly consistent with pathology (Kappa = 0.907), with moderate sequence identity (Kappa = 0.564). There was no significant difference between DWI and McNemar test (P> 0.05). There was significant difference between enhanced sequence and pathological diagnosis (P <0.05). The average ADC value of bladder cancer recurrence was (0.90 ± 0.23) × 10-3mm2 / s, which was significantly lower than that of inflammation (1.32 ± 0.14) × 10-3mm2 / s. The accuracy of ADC value in identifying bladder cancer recurrence and inflammation was high (area under ROC curve = 0.93). The best diagnostic value (sensitivity + specificity = 1.833) was obtained when ADC value was 1.075 × 10-3mm2 / s. Conclusion The DWI sequence is of great value in distinguishing tumor recurrence and inflammatory scar from postoperative bladder cancer and should be used as a routine sequence for bladder MR examination.