Qian Cai, Li Tian, Lingmin Kong, Keyi Zhang, Bei Weng, Bin Huang, Yan Guo, Jun-Xing Chen, Huanjun Wang
{"title":"多参数MRI评估肌肉浸润性膀胱癌患者新辅助治疗后残留肿瘤:指导膀胱保存的可靠工具。","authors":"Qian Cai, Li Tian, Lingmin Kong, Keyi Zhang, Bei Weng, Bin Huang, Yan Guo, Jun-Xing Chen, Huanjun Wang","doi":"10.1007/s00330-025-11773-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical utility of multiparametric MRI in differentiating pathological stages (ypT0 vs ypT1-4) in patients with muscle-invasive bladder cancer (MIBCa) following neoadjuvant therapy (NAT).</p><p><strong>Materials and methods: </strong>In this double-center cohort study, post-NAT multiparametric MRI in all consecutive patients who underwent surgery after NAT was analyzed. Two experienced radiologists independently evaluated the MRI features obtained after NAT. The post-NAT yT stage was assigned based on T2-weighted diffusion-weighted imaging (T2DWI) and on contrast-enhanced MRI scans. The diagnostic accuracies for distinguishing post-NAT ypT0 from ypT1-4 tumors with the two protocols were evaluated. Cohen's kappa (κ) statistics were used to evaluate the consistency between readers for the post-NAT yT stage.</p><p><strong>Results: </strong>A total of 149 patients (mean age, 62 years ± 10 [SD]; 131 men) from two institutions were enrolled. The area under the receiver operating characteristic curve of the contrast-enhanced MRI protocol in predicting post-NAT ypT0 stage was 0.84 (95% CI: 0.77, 0.91), which was better than that of the T2DWI protocol (0.75; 95% CI: 0.67, 0.81; p = 0.002). The interobserver agreement was excellent for both the T2DWI protocol (κ = 0.89) and the contrast-enhanced MRI protocol (κ = 0.85).</p><p><strong>Conclusions: </strong>Multiparametric MRI, particularly contrast-enhanced MRI, demonstrated superior accuracy in identifying ypT0 status following NAT in MIBCa, establishing it as an essential diagnostic tool for guiding bladder preservation in clinical decision-making.</p><p><strong>Key points: </strong>Question Accurately identifying pathological complete response (ypT0) after NAT is essential for selecting bladder-preservation strategies, yet remains clinically challenging. Findings Post-treatment contrast-enhanced MRI accurately identified ypT0 status with an AUC of 0.84 and excellent inter-reader agreement, outperforming T2DWI. Clinical relevance Contrast-enhanced MRI is a reliable, non-invasive method for detecting complete tumor response after NAT, enabling better patient selection for bladder-sparing approaches and potentially improving quality of life.</p>","PeriodicalId":12076,"journal":{"name":"European Radiology","volume":" ","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Multiparametric MRI for assessing residual tumors in patients with muscle-invasive bladder cancer after neoadjuvant treatment: a reliable tool for guiding bladder preservation.\",\"authors\":\"Qian Cai, Li Tian, Lingmin Kong, Keyi Zhang, Bei Weng, Bin Huang, Yan Guo, Jun-Xing Chen, Huanjun Wang\",\"doi\":\"10.1007/s00330-025-11773-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the clinical utility of multiparametric MRI in differentiating pathological stages (ypT0 vs ypT1-4) in patients with muscle-invasive bladder cancer (MIBCa) following neoadjuvant therapy (NAT).</p><p><strong>Materials and methods: </strong>In this double-center cohort study, post-NAT multiparametric MRI in all consecutive patients who underwent surgery after NAT was analyzed. Two experienced radiologists independently evaluated the MRI features obtained after NAT. The post-NAT yT stage was assigned based on T2-weighted diffusion-weighted imaging (T2DWI) and on contrast-enhanced MRI scans. The diagnostic accuracies for distinguishing post-NAT ypT0 from ypT1-4 tumors with the two protocols were evaluated. Cohen's kappa (κ) statistics were used to evaluate the consistency between readers for the post-NAT yT stage.</p><p><strong>Results: </strong>A total of 149 patients (mean age, 62 years ± 10 [SD]; 131 men) from two institutions were enrolled. The area under the receiver operating characteristic curve of the contrast-enhanced MRI protocol in predicting post-NAT ypT0 stage was 0.84 (95% CI: 0.77, 0.91), which was better than that of the T2DWI protocol (0.75; 95% CI: 0.67, 0.81; p = 0.002). The interobserver agreement was excellent for both the T2DWI protocol (κ = 0.89) and the contrast-enhanced MRI protocol (κ = 0.85).</p><p><strong>Conclusions: </strong>Multiparametric MRI, particularly contrast-enhanced MRI, demonstrated superior accuracy in identifying ypT0 status following NAT in MIBCa, establishing it as an essential diagnostic tool for guiding bladder preservation in clinical decision-making.</p><p><strong>Key points: </strong>Question Accurately identifying pathological complete response (ypT0) after NAT is essential for selecting bladder-preservation strategies, yet remains clinically challenging. Findings Post-treatment contrast-enhanced MRI accurately identified ypT0 status with an AUC of 0.84 and excellent inter-reader agreement, outperforming T2DWI. Clinical relevance Contrast-enhanced MRI is a reliable, non-invasive method for detecting complete tumor response after NAT, enabling better patient selection for bladder-sparing approaches and potentially improving quality of life.</p>\",\"PeriodicalId\":12076,\"journal\":{\"name\":\"European Radiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-06-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00330-025-11773-0\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00330-025-11773-0","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Multiparametric MRI for assessing residual tumors in patients with muscle-invasive bladder cancer after neoadjuvant treatment: a reliable tool for guiding bladder preservation.
Objective: To evaluate the clinical utility of multiparametric MRI in differentiating pathological stages (ypT0 vs ypT1-4) in patients with muscle-invasive bladder cancer (MIBCa) following neoadjuvant therapy (NAT).
Materials and methods: In this double-center cohort study, post-NAT multiparametric MRI in all consecutive patients who underwent surgery after NAT was analyzed. Two experienced radiologists independently evaluated the MRI features obtained after NAT. The post-NAT yT stage was assigned based on T2-weighted diffusion-weighted imaging (T2DWI) and on contrast-enhanced MRI scans. The diagnostic accuracies for distinguishing post-NAT ypT0 from ypT1-4 tumors with the two protocols were evaluated. Cohen's kappa (κ) statistics were used to evaluate the consistency between readers for the post-NAT yT stage.
Results: A total of 149 patients (mean age, 62 years ± 10 [SD]; 131 men) from two institutions were enrolled. The area under the receiver operating characteristic curve of the contrast-enhanced MRI protocol in predicting post-NAT ypT0 stage was 0.84 (95% CI: 0.77, 0.91), which was better than that of the T2DWI protocol (0.75; 95% CI: 0.67, 0.81; p = 0.002). The interobserver agreement was excellent for both the T2DWI protocol (κ = 0.89) and the contrast-enhanced MRI protocol (κ = 0.85).
Conclusions: Multiparametric MRI, particularly contrast-enhanced MRI, demonstrated superior accuracy in identifying ypT0 status following NAT in MIBCa, establishing it as an essential diagnostic tool for guiding bladder preservation in clinical decision-making.
Key points: Question Accurately identifying pathological complete response (ypT0) after NAT is essential for selecting bladder-preservation strategies, yet remains clinically challenging. Findings Post-treatment contrast-enhanced MRI accurately identified ypT0 status with an AUC of 0.84 and excellent inter-reader agreement, outperforming T2DWI. Clinical relevance Contrast-enhanced MRI is a reliable, non-invasive method for detecting complete tumor response after NAT, enabling better patient selection for bladder-sparing approaches and potentially improving quality of life.
期刊介绍:
European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field.
This is the Journal of the European Society of Radiology, and the official journal of a number of societies.
From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.