Diffusion kurtosis imaging to assess correlations with clinicopathologic factors for bladder cancer: a comparison between the multi-b value method and the tensor method
- 17 Downloads
To assess the efficacy of diffusion kurtosis imaging (DKI) in differentiating low-grade from high-grade tumors and evaluating the aggressiveness of bladder cancer.
From January 2017 to July 2017, 35 patients (28 males, 7 females; mean age 63 ± 9 years) diagnosed with bladder cancer underwent diffusion-weighted imaging (DWI) with two types of DKI protocols: (1) multi-b value ranging from 0 to 2000 s/mm2 to obtain mean diffusivity/kurtosis (MDb/MKb) and (2) the tensor method with 32 directions with 3 b values (0, 1000, and 2000s/mm2) to obtain mean/axial/radial diffusivity (MDt/Da/Dr), mean/axial/radial kurtosis (MKt/Ka/Kr), and fractional anisotropy (FA) before radical cystectomy. Comparisons between the low- and high-grade groups, non-muscle-invasive bladder cancer (NMIBC), and muscle-invasive bladder cancer (MIBC) were performed with the areas under the receiver operating characteristic curves (AUCs).
The MKt and Kr values were significantly (p = 0.017 and p = 0.048) higher in patients with high-grade bladder tumors than in those with low-grade tumors. The MKt, Kr, and MKb values were significantly (p = 0.022, p = 0.000, and p = 0.044, respectively) higher in patients with MIBC than in those with NMIBC, while no significant differences (p > 0.05) were found in other values. The AUC of Kr (0.883) was the largest and was significantly higher than those of other metrics (all p < 0.05) for differentiating MIBC from NMIBC, with a sensitivity and specificity of 81.8% and 91.7%, respectively.
Kurtosis metrics performed better than diffusion metrics in differentiating MIBC from NMIBC, and directional kurtosis and Kr metrics may also have great potential in providing additional information regarding bladder cancer invasiveness.
• Kurtosis metrics performed better than diffusion metrics in differentiating muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC).
• Directional kurtosis can provide additional directional microstructural information regarding bladder cancer invasiveness.
KeywordsCystectomy Urinary bladder neoplasms Magnetic resonance imaging Diffusion magnetic resonance imaging Diffusion tensor imaging
Apparent diffusion coefficient
Area under the receiver operating characteristic curve
Constrained linear least-square
Diffusion kurtosis tensor
Diffusion tensor imaging
Intraclass correlation coefficient
Muscle-invasive bladder cancer
Magnetic resonance imaging
Non-muscle-invasive bladder cancer
Receiver operator characteristic
This study has received funding from the National Natural Science Foundation of China (Youth Program Nos. 81601487, 81672514).
Compliance with ethical standards
The scientific guarantor of this publication is Jian-Rong Xu.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Study subjects or cohorts overlap have not been published previously and not under consideration for publication elsewhere, in whole or in part.
• diagnostic study
• performed at one institution
- 1.Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300Google Scholar
- 2.Rabie E, Faeghi F, Izadpanahi MH, Dayani MA (2016) Role of dynamic contrast-enhanced magnetic resonance imaging in staging of bladder cancer. J Clin Diagn Res 10:TC01–TC05Google Scholar
- 4.Rosenkrantz AB, Mussi TC, Spieler B, Melamed J, Taneja SS, Huang WC (2012) High-grade bladder cancer: association of the apparent diffusion coefficient with metastatic disease: preliminary results. J Magn Reson Imaging 35:1478–1483Google Scholar
- 5.Dağgülli M, Onur MR, Fırdolaş F, Onur R, Kocakoç E, Orhan İ (2011) Role of diffusion MRI and apparent diffusion coefficient measurement in the diagnosis, staging and pathological classification of bladder tumors. Urol Int 87:346–352Google Scholar
- 8.El-Assmy A, Abou-El-Ghar ME, Refaie HF, Mosbah A, El-Diasty T (2012) Diffusion-weighted magnetic resonance imaging in follow-up of superficial urinary bladder carcinoma after transurethral resection: initial experience. BJU Int 110:E622–E627Google Scholar
- 9.Jensen JH, Helpern JA, Ramani A, Lu H, Kaczynski K (2005) Diffusional kurtosis imaging: the quantification of non-Gaussian water diffusion by means of magnetic resonance imaging. Magn Reson Med 53:1432–1440Google Scholar
- 10.Tabesh A, Jensen JH, Ardekani BA, Helpern JA (2011) Estimation of tensors and tensor-derived measures in diffusional kurtosis imaging. Magn Reson Med 65:823–836Google Scholar
- 12.O'Brien T, Cranston D, Fuggle S, Bicknell R, Harris AL (1995) Different angiogenic pathways characterize superficial and invasive bladder cancer. Cancer Res 55:510–513Google Scholar
- 26.Hui ES, Cheung MM, Qi L, Wu EX (2008) Towards better MR characterization of neural tissues using directional diffusion kurtosis analysis. Neuroimage 42:122–134Google Scholar