The role of multiparametric magnetic resonance imaging in the differentiation of low-and high-grade non-muscle invasive bladder cancer - Original Article

Q: What was the main purpose of this study?

To evaluate how well ADC measurements and semiquantitative DCE parameters can predict differentiation between low-grade and high-grade NMIBC.

Q: How were ADC and DCE parameters measured and compared?

ADC was calculated using three-region-of-interest (ADCt) and whole volume (ADCw) methods, with corresponding ratios (ADCtR, ADCwR). DCE wash-in rate (WiR), wash-out ratio (WoR), time to peak (TTP), and peak enhancement (PE) were also computed and analyzed.

Q: Which imaging metric showed the best diagnostic value?

ADCtR had the best diagnostic value for differentiating low- versus high-grade NMIBC for both readers, with improved accuracy, sensitivity, specificity, and AUC.

Sep 22, 2026

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This study evaluates the diagnostic performance of multiparametric MRI for differentiating low-grade from high-grade non-muscle invasive bladder cancer (NMIBC). Apparent diffusion coefficient (ADC) metrics were assessed using three-region-of-interest (ADCt) and whole volume (ADCw) approaches, including ratio forms (ADCtR, ADCwR). Semiquantitative dynamic contrast enhancement (DCE) parameters (wash-in rate, wash-out ratio, time to peak, and peak enhancement) were also analyzed. Among 89 histopathologically confirmed patients, ADCtR showed the best overall discrimination for both readers, while most DCE semiquantitative parameters did not significantly separate tumor grades.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Purpose

Methods

Results

Conclusion

Clinical Significance

Keywords

Copyright@Author(s) -[Available online at dirjournal.org](Available online at dirjournal.org). Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. ORIGINAL ARTICLE The role of multiparametric magnetic resonance imaging in the differentiation of low-and high-grade non-muscle invasive bladder cancer Merve Nur Taşdemir 1 Uluhan Eryürük1 Ural Oğuz2 BirgülTok3 Serdar Aslan1 1Giresun University Faculty of Medicine, Department of Radiology, Giresun, Türkiye 2Giresun University Faculty of Medicine, Department of Urology, Giresun, Türkiye 3Giresun University Faculty of Medicine, Department of Pathology, Giresun, Türkiye Corresponding author: Merve Nur Taşdemir [E-mail:](E-mail: mervetsdmr@gmail.com)[ mervetsdmr@gmail.com](E-mail: mervetsdmr@gmail.com) Received 29 August 2024; revision requested 02 October 2024; last revision received 10 October 2024; accepted 20 October 2024. Epub: 25.11.2024 Publication date: 08.07.2025 DOI: 10.4274/dir.2024.243004 PURPOSE To evaluate the diagnostic efficacy of apparent diffusion coefficient (ADC) measurements and semiquantitative dynamic contrast enhancement (DCE) parameters in predicting the differentiation between low-and high-grade tumors in non-muscle invasive bladder cancers (NMIBC) . METHODS Patients with NMIBC, who were histopathologically confirmed between August 2020 and July 2023, were analyzed by 2 radiologists with different levels of experience. DCE semi-quantitative parameters such as wash-in rate (WiR), wash-out ratio (WoR), time to peak (TTP), and peak enhancement (PE) were calculated. ADC measurements were performed using the three-region-of-interest (ADCt) and whole volume (ADCw) methods; ADCt ratio (ADCtR) and ADCw ratio (ADCwR) were also calculated. Receiver operating characteristic curve analysis was performed to demonstrate the cut-off values of ADCt, ADCw, ADCtR, and ADCwR to differentiate low-and high-grade tumors. The intraclass correlation coefficient was used to evaluate inter-reader agreement. RESULTS A total of 89 patients were included in this study. Of these patients, 48 had low-grade NMIBC, and 41 had high-grade NMIBC. There was no significant difference in mean WoR, WiR, TTP, and PE values between low-and high-grade NMIBC (P > 0.05) . The ADCt, ADCw, ADCtR, and ADCwR values of high-grade NMIBC were significantly lower than those of low-grade NMIBC (P < 0.001). With cut-off values of 0.449 and 0.435, ADCtR had the best diagnostic value for both readers, showing better accuracy, sensitivity, specificity, and area under the curve (85.4%–83.1%, 87.5%–85.4%, 82.9%–80.4%, and 0.879–0.857, respectively, with confidence intervals) . Additionally, ADCtR and ADCt showed acceptable diagnostic performance for both readers, with cut-off values of 0.439 and 0.431, respectively, for differentiating Ta-and T1-stages. The inter-reader agreement was almost perfect for ADC measurements. CONCLUSION While DCE semiquantative parameters did not yield significant outcomes in distinguishing between low and high grades, ADCtR holds promise for enhancing patient management in NMIBC cases and stands as a potential preoperative radiological asset. CLINICAL SIGNIFICANCE Individuals diagnosed with NMIBC may require different treatment approaches; therefore, it is very important to distinguish between low-and high-grade cases preoperatively. The differentiation between the Ta-and T1-stages is recognized as crucial in patient treatment strategies. Furthermore, ADCtR shows promise for improving patient management in NMIBC cases. KEYWORDS Apparent diffusion coefficient reference, apparent diffusion coefficient ratio, non-muscle invasive bladder cancer, magnetic resonance imaging, diffusion-weighted imaging, apparent diffusion coefficient You may cite this article as: Taşdemir MN, Eryürük U, Oğuz U, Tok B, Aslan S. The role of multiparametric magnetic resonance imaging in the diff

FAQs

What was the main purpose of this study?

To evaluate how well ADC measurements and semiquantitative DCE parameters can predict differentiation between low-grade and high-grade NMIBC.

How were ADC and DCE parameters measured and compared?

ADC was calculated using three-region-of-interest (ADCt) and whole volume (ADCw) methods, with corresponding ratios (ADCtR, ADCwR). DCE wash-in rate (WiR), wash-out ratio (WoR), time to peak (TTP), and peak enhancement (PE) were also computed and analyzed.

Which imaging metric showed the best diagnostic value?

ADCtR had the best diagnostic value for differentiating low- versus high-grade NMIBC for both readers, with improved accuracy, sensitivity, specificity, and AUC.

Sep 22, 2026

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