Multiparametric magnetic resonance imaging for bladder cancer: a comprehensive systematic review of the Vesical Imaging-Reporting and Data System (VI-RADS) performance and potential clinical applications

Abstract

Background: The Vesical Imaging-Reporting and Data System (VI-RADS) score is a novel standardized approach to image and report bladder cancer (BC) with multiparametric MRI (mpMRI). Objectives: To describe and evaluate the performance of the VI-RADS score using mpMRI and assess its potential clinical applications and limitations. Methods: A systematic review was conducted using the MEDLINE and EMBASE electronic bibliographic databases between June 2020 and December 2020. All reports deemed relevant to describe the VI-RADS score and assess its performance and applications were retrieved. Results presentation stands as narrative, purely descriptive synthesis based on aggregate studies data. Results: A total of 20 relevant studies were retrieved: three meta-analyses, five prospective studies, and twelve retrospective studies. The retrospective studies covered 1676 patients, while the prospective studies included a total number of 468 patients. Pooled sensitivity, specificity to differentiate muscle-invasive from non-muscle-invasive bladder cancer, ranged from 74.1% to 97.3%, and 77% to 100%, respectively. The chosen VI-RADS score thresholds for this discrimination varied across studies. The interreader agreement ranged from 0.73 to 0.95. Currently, the potential clinical applications of VI-RADS consist of initial BC risk stratification, assessment of neoadjuvant therapies response, and bladder sparing approaches, although further validation is required. Conclusions: The VI-RADS score helps to discriminate muscle invasive from non-muscle invasive BC with good performance and reproducibility. A simple algorithm based on four basic questions may enhance its popularization. Further studies are required to validate the clinical applications.

Diffusion-weighted MRI to determine response and long-term clinical outcomes in muscle-invasive bladder cancer following neoadjuvant chemotherapy

“…Qualitative DWI response reporting appears reliant on expertise. Although inter-reader agreement is good in the diagnostic setting ( 43 ), identifying complete treatment response is subject to greater reporting variation ( 44 ). Quantitative image analysis, therefore, has the potential to overcome reporting discrepancy.…”

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“…When used in tangent with preoperative imaging methods such as magnetic resonance imaging (MRI), they may help guide bladder cancer risk stratification and the use of organ‐sparing techniques. Recent systematic review analysed the use of MRI as part of the Vesical Imaging Reporting and Data System (VI‐RADS), which can be used to distinguish MIBC from NMIBC using multiparametric MRI, concluding that its use confers good performance and reproducibility 49,50 . Though, its application in organ‐sparing risk stratification may be limited by its purported propensity to overstage bladder cancer in up to one third of patients 51 …”

The use of MRI in urothelial carcinoma

“…VI-RADS clinical impact and mpMRI of the bladder diagnostic performance have been widely investigated and validated, proving the high accuracy and reliability, especially thanks to the strong inter-reader agreement, as indicated by numerous level 2a original investigations and meta-analyses (Table 1) [27 ▪ ,28 ▪ ,29 ▪ ,30 ▪ ,31 ▪ ,32–42].…”