Abstract 229P
Background
Differences in treatment paradigms and prognosis based on tumor aggressiveness emphasized the urgent need to accurately detect muscle invasion of bladder cancer. DWI, based on the hypothesis that diffusion follows by Gaussian distribution, has shown great promise in differentiating MIBC and NMIBC. DKI is believed to better reflect the deviation from a Gaussian distribution due to irregularity and heterogeneity of cell microstructure and tissue components. Therefore, the present study was designed to quantitatively investigate the diagnostic performances of DKI in predicting aggressiveness of bladder cancer and to compare the potential of parameters obtained from DWI and DKI.
Methods
Multiple b value DWIs were performed using a 3.0-T magnetic resonance imaging unit in 61 patients with bladder cancer including MIBC and NMIBC confirmed by histopathological findings. DWI data were postprocessed using mono-exponential and DKI models to calculate the apparent diffusion coefficient, apparent diffusional kurtosis, and kurtosis-corrected diffusion coefficient. Receiver-operating characteristic analysis was performed to compare the diagnostic efficacy of all diffusion parameters. SPSS and MedCalc were used to perform the statistical analyses. ADC and DKI parameters were measured and processed using IMAge/enGINE MR_Diffusion (an open-source software).
Results
Both ADC and DKI values differed significantly between MIBC and NMIBC. The ADC and Dapp values of the MIBC group were lower than the NMIBC group (all p<0.001), whilst Kapp values were higher than those of the NMIBC group (p<0.001). The AUC values of ADC, Dapp and Kapp were 0.833, 0.859, and 0.920 for differentiating MIBC from NMIBC, respectively. The combination of Dapp and Kapp value had the highest AUC of 0.944. For pairwise comparisons of ROC curves, ADC was worse than Kapp (p=0.030), and worse than the combination of Dapp and Kapp (p=0.007). ADC was not significantly different from Dapp (p=0.528).
Conclusions
Both conventional DWI and DKI models are beneficial in differentiating between MIBC and NMIBC, whilst Kapp and the combination of Dapp and Kapp could produce more robust values than conventional ADC in evaluating aggressiveness of bladder cancer.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Zhongshan Hospital Affiliated to Fudan University.
Funding
Natural Science Foundation of China.
Disclosure
All authors have declared no conflicts of interest.
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