title: Contrast-enhanced dynamic and diffusion-weighted MR imaging at 3.0T to assess aggressiveness of bladder cancer.
abstract: BACKGROUND
  Diffusion weighted magnetic resonance imaging (DWI) and dynamic contrast-enhanced (DCE) MRI have been considered useful for pathological staging and histological grading in bladder cancer. To our knowledge, no study has combined the two imaging modalities together to assess aggressiveness of bladder cancer.
  
  
  OBJECTIVE
  To assess the clinical aggressiveness of bladder cancer with DCE MRI and DWI at 3.0T.
  
  
  METHODS
  A total of 59 patients with 69 pathologically confirmed tumor lesions were included in this study. All patients underwent MR examination at 3.0T basing on DWI and DCE imaging. Tumor staging and histological grade were evaluated. The aggressiveness of bladder cancer was classified as low-, intermediate-, or high-aggressiveness according to its pathological phenotype. Apparent diffusion coefficient (ADC) value and semi-quantitative parameters (wash-in rate and wash-out rate) were determined. The correlation between clinical aggressiveness and ADC value, wash-in rate and wash-out rate were analyzed. In addition, the diagnostic accuracy of the diffusion and semi-quantitative parameters were estimated using receiver operating characteristic curve (ROC).
  
  
  RESULTS
  Aggressiveness of bladder cancer is negatively correlated with ADC value (r=-0.705, p<0.0001) and wash-out rate (r=-0.719, p<0.0001). The tumor ADC value is positively correlated with wash-out rate (r=0.555, p<0.0001). The diagnostic specificity and accuracy using tumor ADC value and wash-out for the tumor with size <24mm were better than that tumors with size ≥24mm. The sensitivity, specificity and accuracy of ADC and wash-out rate in combination in diagnosis of bladder cancer aggressiveness were 96.7%, 94.9% and 95.7%, respectively. ROC curve revealed the diagnostic performance of aggressiveness of bladder cancer using ADC value and wash-out rate were 0.928 (cut-off value: 0.905×10(-3)mm(2)/s) and 0.891 (cut-off value: 0.685min(-1)), respectively.
  
  
  CONCLUSIONS
  ADC and wash-out rate derived from DWI and DCE-MRI at 3.0T have good potential to assess the aggressiveness of bladder cancer and the accuracy was greater for ADC than for semi-quantitative parameters.
authors.affiliation: Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China. Electronic address: sheasthospital@163.com.
authors.forename: Guoxing
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China; Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China. Electronic address: chx_win@163.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China. Electronic address: zjh1830@easthospital.cn.
authors.forename: Jingqi
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China. Electronic address: zgl0577@easthospital.cn.
authors.forename: Genlin
authors.initials: G
authors.lastname: Zong
authors.affiliation: Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China. Electronic address: zhq2001us@163.com.
authors.forename: Zhongqiu
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
chemical_list: D003287:Contrast Media
keywords: Apparent diffusion coefficient; Bladder cancer; Dynamic contrast enhancement; Magnetic resonance imaging