Background Accurate evaluation of the invasion depth of tumors with a Vesical Imaging‐Reporting and Data System (VI‐RADS) score of 3 is difficult. Purpose To evaluate the diagnostic performance of a new magnetic resonance imaging (MRI) strategy based on the integration of the VI‐RADS and tumor contact length (TCL) for the diagnosis of muscle‐invasive bladder cancer (MIBC). Study type Single center, retrospective. Subjects A group of 179 patients with a mean age of 67 years (range, 24.0–96.0) underwent multiparametric MRI (mpMRI) before surgery, including 147 (82.1%) males and 32 (17.9%) females. Twenty‐four (13.4%), 90 (50.3%), 43 (24.0%), 15 (8.4%), and 7 (3.9%) cases were Ta, T1, T2, T3, and T4, respectively. Field Strength/Sequence A 1.5 T and 3.0 T, T2‐weighted turbo spin‐echo (TSE), single‐shot echo‐planar (SS‐EPI), diffusion‐weighted imaging (DWI), and T1‐weighted volumetric interpolated breath‐hold examination (T1‐VIBE). Assessment Three radiologists independently graded the VI‐RADS score and measured the TCL on index lesion images. A proposed MRI strategy called VI‐RADS_TCL was introduced by modifying the VI‐RADS score, which was downgraded to VI‐RADS 3F (equal to a VI‐RADS score of 2) if VI‐RADS = 3 and TCL < 3 cm. Statistical Tests Intraclass correlation coefficients (ICCs), Mann–Whitney U test, chi‐square tests, receiver operating characteristic (ROC) curves, and 2 × 2 contingency tables were applied. Results Inter‐reader agreement values were 0.941 (95% CI, 0.924–0.955) and 0.934 (95% CI, 0.916–0.948) for the TCL and VI‐RADS score. The TCL was significantly increased in the MIBC group (6.40–6.85 cm) compared with the NMIBC group (1.98–2.45 cm) (P < 0.05). The specificity and positive predictive values (PPV) of VI‐RADS_TCL were 82.46%–87.72% and 90.91%–91.59%, which were significantly greater than VI‐RADS score (P < 0.05). Additionally, 52.17%–55.88% NMIBC lesions with VI‐RADS 3 were downgraded to 3F by using VI‐RADS_TCL. Data Conclusion The proposed MRI strategy could reduce the false‐positive rate of lesions with a VI‐RADS score of 3 while retaining sensitivity. Evidence Level 4 Technical Efficacy 2
Bladder cancer is a common malignant tumor in the urinary system. Depending on whether bladder cancer invades muscle tissue, it is classified into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). It is crucial to accurately diagnose the muscle invasion of bladder cancer for its clinical management. Although imaging modalities such as CT and multiparametric MRI play an important role in this regard, radiomics has shown great potential with the development and innovation of precision medicine. It features outstanding advantages such as non-invasive and high efficiency, and takes on important significance in tumor assessment and laor liberation. In this article, we provide an overview of radiomics in the prediction of muscle-invasive bladder cancer and reflect on its future trends and challenges.
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