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• Clinical Article •
The value of intravoxel incoherent motion diffusion weighted imaging in the evaluation of bladder cancer grade and myometrial invasion
LIU Huaqiong  ZHANG Jingjing  ZHANG Zhiqing  XU Wanbo  XU Chang 

Cite this article as: LIU H Q, ZHANG J J, ZHANG Z Q, et al. The value of intravoxel incoherent motion diffusion weighted imaging in the evaluation of bladder cancer grade and myometrial invasion[J]. Chin J Magn Reson Imaging, 2025, 16(9): 118-123. DOI:10.12015/issn.1674-8034.2025.09.018.


[Abstract] Objective To explore the clinical value in predicting high/low grade bladder carcinoma and muscle layer invasive bladder carcinoma (MIBC) and non-myoinvasive bladder carcinoma (NMIBC) with various parameter values of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI).Materials and Methods Including 57 patients with bladder cancer, all of them underwent preoperative bladder multi-parameter magnetic resonance imaging (mp-MRI) (including T2WI, IVIM-DWI, and DWI). The patients were classified into high-grade and low-grade bladder cancer groups based on the degree of differentiation of bladder cancer; and into MIBC and NMIBC groups based on whether the bladder cancer had infiltrated the muscle layer of the bladder wall. Two physicians independently delineated region of interest (ROI) for the bladder cancer lesions on IVIM-DWI images (b = 800 s/mm²), calculated the intra-group correlation coefficients (ICC), and evaluated the repeatability and consistency of the measurement results. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion fraction (f), and perfusion-related diffusion coefficient (D*) were analyzed. Establish a binary logistic regression model, combining the parameter values to calculate the prediction values for different grades of bladder cancer and whether there is muscle invasion, both independently and in combination. Use the area under the receiver operating characteristic curve (AUC) to evaluate the diagnostic value of IVIM-DWI in predicting high-grade, low-grade, and muscle-invasive bladder cancer. The comparison of AUCs uses the DeLong test.Results The ADC, D, and f values measured by different physicians and the same physician on three occasions showed good repeatability (ICC range 0.916 to 0.991). The ADC, D, and f values for high-grade bladder cancer group were (1.403 ± 0.575) × 10-3 mm2/s, (7.276 ± 5.895) × 10-3 mm2/s, and 0.490 ± 0.203, all lower than those of the low-grade bladder cancer group [ADC, D, and f values were (1.810 ± 0.288) × 10-3 mm2/s, (19.522 ± 6.274) × 10-3 mm2/s, and 0.873 ± 0.174; P < 0.001]; the ADC, D, and f values for MIBC group were (1.382 ± 0.334) × 10-3 mm2/s, (9.686 ± 9.069) × 10-3 mm2/s, and 0.543 ± 0.261, all lower than those of the NMIBC group [ADC, D, and f values were (1.822 ± 0.445) × 10-3 mm2/s, (18.116 ± 6.490) × 10-3 mm2/s, and 0.842 ± 0.193; P < 0.001]. After DeLong testing, in both high-grade and low-grade bladder cancer groups, the independent predictive efficacy of ADC, D, and f was lower than that of their combined use (AUC = 0.774, 0.822, 0.801, 0.869), with statistically significant differences (P = 0.018, 0.027, 0.028); in MIBC and NMIBC groups, the independent predictive efficacy of ADC, D, and f was also lower than that of their combined use (AUC = 0.568, 0.595, 0.623, 0.671), with statistically significant differences (P = 0.009, 0.034, 0.024).Conclusions The combined predictive efficacy of ADC, D and f values of IVIM-DWI for high-grade and low-grade bladder cancer, MIBC and NMIBC was higher than that of independent predictive efficacy. It can be used to preoperative prediction of bladder cancer grade and presence or absence of bladder wall muscle infiltration.
[Keywords] bladder cancer；grade；myometrial invasion；multi-parametric magnetic resonance imaging；intravoxel incoherent motion diffusion-weighted imaging

LIU Huaqiong1, 2   ZHANG Jingjing1   ZHANG Zhiqing1   XU Wanbo2   XU Chang1*  

1 Department of Radiology, Binzhou Medical University Hospital, Binzhou 256603, China

2 Department of Radiology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou 253000, China

Corresponding author: XU C, E-mail: xuchang3183@126.com

Conflicts of interest   None.

Received  2025-02-21
Accepted  2025-08-25
DOI: 10.12015/issn.1674-8034.2025.09.018
Cite this article as: LIU H Q, ZHANG J J, ZHANG Z Q, et al. The value of intravoxel incoherent motion diffusion weighted imaging in the evaluation of bladder cancer grade and myometrial invasion[J]. Chin J Magn Reson Imaging, 2025, 16(9): 118-123. DOI:10.12015/issn.1674-8034.2025.09.018.

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