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Radiomics analysis of multiparametric MRI for the preoperative evaluation of pathological grade in bladder cancer tumors



To develop and validate an MRI-based radiomics strategy for the preoperative estimation of pathological grade in bladder cancer (BCa) tumors.


A primary cohort of 70 patients (31 high-grade BCa and 39 low-grade BCa) with BCa were retrospectively enrolled. Three sets of radiomics features were separately extracted from tumor volumes on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. Two sets of multimodal features were separately generated by the maxout and concatenation of the above mentioned single-modality features. Each feature set was subjected to a two-sample t test and the least absolute shrinkage and selection operator (LASSO) algorithm for feature selection. Multivariable logistic regression (LR) analysis was used to obtain five corresponding radiomics models. The diagnostic abilities of the radiomics models were evaluated using receiver operating characteristic (ROC) curve analysis and compared using the DeLong test. Validation was performed on a time-independent cohort containing 30 consecutive patients.


The areas under the ROC curves (AUCs) of single-modality T2WI, DWI, and ADC models in the training cohort were 0.7933 (95% confidence interval [CI] 0.7471–0.8396), 0.8083 (95% CI 0.7565–0.8601), and 0.8350 (95% CI 0.7924–0.8776), respectively. Both multimodality models achieved higher AUCs (maxout 0.9233, 95% CI 0.9001–0.9466; concatenation 0.9233, 95% CI 0.9001–0.9466) than single-modality models. The AUCs of the maxout and concatenation models in the validation cohort were 0.9186 and 0.9276, respectively.


The MRI-based multiparametric radiomics approach has the potential to be used as a noninvasive imaging tool for preoperative grading of BCa tumors. Multicenter validation is needed to acquire high-level evidence for its clinical application.

Key Points

• Multiparametric MRI may help in the preoperative grading of BCa tumors.

• The Joint_Model established from T2WI, DWI, and ADC feature subsets demonstrated a high diagnostic accuracy for preoperative prediction of pathological grade in BCa tumors.

• The radiomics approach has the potential to preoperatively assess tumor grades in BCa and avoid subjectivity.

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Apparent diffusion coefficient


Area under the curve


Bladder cancer


Confidence interval


Diffusion tensor imaging


Diffusion-weighted imaging


Least absolute shrinkage and selection operator


Muscle-invasive bladder cancer


Non-muscle-invasive bladder cancer


Perfusion-weighted imaging


Receiver operating characteristic


Tumor in situ


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The abstract of this study has been accepted as a scientific oral presentation at the European Congress of Radiology 2019 annual meeting.


This study has received funding by National Natural Science Foundation of China (81701747) and Natural Science Foundation of Guangdong Province (2017A030313902).

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Corresponding authors

Correspondence to Yanqiu Feng or Yan Guo.

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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.


The scientific guarantors of this publication are Yanqiu Feng and Yan Guo.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board of the First Affiliated Hospital of Sun Yat-sen University.

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Ethical approval was obtained from the Institutional Review Board of The First Affiliated Hospital of Sun Yat-sen University.


• retrospective

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• performed at one institution

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Wang, H., Hu, D., Yao, H. et al. Radiomics analysis of multiparametric MRI for the preoperative evaluation of pathological grade in bladder cancer tumors. Eur Radiol 29, 6182–6190 (2019).

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  • Magnetic resonance imaging
  • Urinary bladder
  • ROC curve
  • Regression analysis