| Objectives:To explore the difference in the accuracy of mpMRI in diagnosis and staging of bladder urothelial carcinoma under different states of bladder distention in clinical practice,and explore the best bladder distention state and filling volume suitable for mpMRI examination.To analyze the related factors that may affect the status of patient’s bladder distention during mpMRI examination,so as to provide reference for clinical practice.Methods:Clinical data of 365 patients with bladder urothelial carcinoma who were admitted to the Department of Urology,The Second Affiliated Hospital of Kunming Medical University from January 2016 to June 2020 were retrospectively analyzed.All patients were initially diagnosed with bladder urothelial carcinoma and underwent mpMRI examination with the same bladder filling preparation,all patients underwent surgical treatment and obtained complete tumor specimens within two weeks after examination.Two radiologists with equivalent qualifications and rich experience independently performed the preoperative diagnosis and staging of the patients’ bladder urothelial carcinoma using mpMRI images,the final staging results were obtained by unifying the two opinions.Use the ROI drawing tool in the computer image display system of our hospital to check the bladder area of the patient’s MRI images and calculate the bladder filling volume of each patient and the prostate volume of male patients.A radiologist familiar with pelvic MRI uses the Likert 5-point scale to score the patient’s bladder distention status.In addition,relevant data such as patient age,gender,tumor pathological staging and grading,and the number of white blood cells in urine microscopy were also collected.Perform descriptive statistics on the distribution of bladder filling under different Likert scores,analyze the difference in the composition of bladder filling under each score by Kruskal-Wallis H rank test,and use Spearman correlation analysis to analyze the difference between bladder filling and Likert score Correlation.The chi-square test was used to compare the differences in the accuracy of mpMRI diagnosis of bladder cancer under different Likert scores;and the Fisher’s exact test was used to compare the cases of too high or too low staging of bladder urothelial carcinoma with different Likert scores when the diagnostic staging of bladder cancer with mpMRI is not consistent with the pathological staging.Finally,the relevant factors that may affect the patient’s bladder distention status during mpMRI examination were analyzed by multivariate Logistic regression and Spearman correlation analysis.Results:A total of 365 subjects were included,including 301 males and 64 females.The difference of bladder filling volume distribution under different Likert scores was statistically significant(x2=274.067,P<0.01)There was a significant positive correlation between Likert score and bladder filling volume(rs=0.866,P<0.01),with the increase of Likert score value,the corresponding bladder filling volume increased.Among the five Likert rating groups,the difference in diagnostic accuracy of mpMRI diagnosis of bladder urothelial carcinoma between the 3 and 4 scores and the 1,2 and 5 scores was statistically significant(x2=18.186,P=0.01).Bladder distention to 3 and 4 points of Likert score was the most accurate state for mpMRI diagnosis of bladder urothelial carcinoma,with the accuracy of 92.4%and 90.8%,respectively,and the corresponding bladder filling volume was 116-348ml.There was no statistical significance in the number of cases with high or low pathological stage of bladder urothelial carcinoma diagnosed by mpMRI in each Likert rating group(x2=7.382,P=0.112),indicating that under different bladder filling conditions,there was no significant difference in the occurrence of MRI staging that is too high or too low.Multivariate logistic regression analysis showed that the patient’s gender was the influencing factor of Likert score.Under the same bladder filling preparation,male patients had lower Likert score than female patients(β=-1.052,P<0.05).The number of white blood cells in urine was also an influencing factor of Likert score,and there was a negative correlation between them(β=-0.212,P=0.013).The more white blood cells in urine microscopy,the lower the Likert score.Spearman correlation analysis showed that prostate volume is not a factor affecting the Likert score of male patients(rs=-0.068,P=0.246).Conclusions:1.The distention state of the bladder in patients undergoing mpMRI examination greatly affects the performance of mpMRI in diagnosing bladder cancer.Without distention or overdistention,the accuracy of the diagnosis staging is greatly reduced.Compared with pathological staging,both excessive and insufficient staging of imaging stage exist.2.The Likert score of the patient’s bladder during mpMRI examination is an easy way to assess the state of bladder distention.Likert score of 3 or 4 is highly accurate in diagnosing bladder urothelial carcinoma.The radiologists can score each patient first.If a score of 3 or 4 is not met,the patient can be asked to make additional preparations for the examination after the bladder distention reaches the standard.Surgeons should also conduct autonomous assessments of the patient’s mpMRI images.For patients’bladder without distention or overdistention,comprehensive assessment of the disease should be fully combined with the results of TURBT pathological diagnosis.3.The patient’s gender and the presence or absence of urinary tract infection during mpMRI examination affect the preparation for bladder filling before the examination.For patients with urinary tract infections,the control of urinary tract infection is important for bladder filling preparations for mpMRI.Elderly males have poorer bladder distention than female patients,the effect of BPH on bladder filling preparation in male patients needs further research. |
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