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Evaluation of a fractional-order calculus diffusion model and bi-parametric VI-RADS for staging and grading bladder urothelial carcinoma

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Abstract

Objectives

To evaluate the feasibility of high b-value diffusion-weighted imaging (DWI) for distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) and low- from high-grade bladder urothelial carcinoma using a fractional-order calculus (FROC) model as well as a combination of FROC DWI and bi-parametric Vesical Imaging-Reporting and Data System (VI-RADS).

Methods

Fifty-eight participants with bladder urothelial carcinoma were included in this IRB-approved prospective study. Diffusion-weighted images, acquired with 16 b-values (0–3600 s/mm2), were analyzed using the FROC model. Three FROC parameters, D, β, and μ, were used for delineating NMIBC from MIBC and for tumor grading. A receiver operating characteristic (ROC) analysis was performed based on the individual FROC parameters and their combinations, followed by comparisons with apparent diffusion coefficient (ADC) and bi-parametric VI-RADS based on T2-weighted images and DWI.

Results

D and μ were significantly lower in the MIBC group than in the NMIBC group (p = 0.001 for each), and D, β, and μ all exhibited significantly lower values in the high- than in the low-grade tumors (p ≤ 0.011). The combination of D, β, and μ produced the highest specificity (85%), accuracy (78%), and the area under the ROC curve (AUC, 0.782) for distinguishing NMIBC and MIBC, and the best sensitivity (89%), specificity (86%), accuracy (88%), and AUC (0.892) for tumor grading, all of which outperformed the ADC. The combination of FROC parameters with bi-parametric VI-RADS improved the AUC from 0.859 to 0.931.

Conclusions

High b-value DWI with a FROC model is useful in distinguishing NMIBC from MIBC and grading bladder tumors.

Key Points

• Diffusion parameters derived from a FROC diffusion model may differentiate NMIBC from MIBC and low- from high-grade bladder urothelial carcinomas.

• Under the condition of a moderate sample size, higher AUCs were achieved by the FROC parameters D (0.842) and μ (0.857) than ADC (0.804) for bladder tumor grading with p ≤ 0.046.

• The combination of the three diffusion parameters from the FROC model can improve the specificity over ADC (85% versus 67%, p = 0.031) for distinguishing NMIBC and MIBC and enhance the performance of bi-parametric VI-RADS.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

BC:

Bladder cancer

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

FOV:

Field of view

FROC:

Fractional-order calculus

FSE:

Fast spin-echo

MIBC:

Muscle-invasive bladder cancer

NMIBC:

Non-muscle-invasive bladder cancer

ROC:

Receiver operating characteristic

TURBT:

Transurethral resection of bladder tumor

VI-RADS:

Vesical Imaging Reporting and Data System

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Acknowledgements

The authors would like to thank Dr. Qingfei Luo, Dr. Kaibao Sun, Dr. Kezhou Wang, and Dr. Rahul Mehta of the University of Illinois at Chicago for helpful discussions.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Drs. Xiaohong Joe Zhou and Daoyu Hu are the senior authors who share the co-corresponding authorship.

Authors and Affiliations

  1. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China

    Cui Feng, Yanchun Wang, Zhen Li & Daoyu Hu

  2. Center for MR Research, University of Illinois at Chicago, MC-707, Suite 1A, 1801 West Taylor Street, Chicago, IL, 60612, USA

    Cui Feng, Guangyu Dan, Zheng Zhong, M. Muge Karaman & Xiaohong Joe Zhou

  3. Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA

    Guangyu Dan, Zheng Zhong, M. Muge Karaman & Xiaohong Joe Zhou

  4. Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA

    Xiaohong Joe Zhou

  5. Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

    Xiaohong Joe Zhou

Authors
  1. Cui Feng
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Corresponding authors

Correspondence to Daoyu Hu or Xiaohong Joe Zhou.

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Guarantor

The scientific guarantor of this publication is Cui Feng.

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

One of the authors (M. Muge Karaman) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all participants in this study.

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Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Feng, C., Wang, Y., Dan, G. et al. Evaluation of a fractional-order calculus diffusion model and bi-parametric VI-RADS for staging and grading bladder urothelial carcinoma. Eur Radiol 32, 890–900 (2022). https://doi.org/10.1007/s00330-021-08203-2

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  • DOI: https://doi.org/10.1007/s00330-021-08203-2

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