Vesical Imaging-Reporting and Data System (VI-RADS) for assessment of response to systemic therapy for bladder cancer: preliminary report

Abstract

Purpose The Vesical Imaging-Reporting and Data System (VI-RADS) criteria are expanding, providing fine differentiation of bladder wall layers involvement. We aimed to explore the feasibility of a novel categorical scoring, the Neoadjuvant chemotherapy VI-RADS (nacVI-RADS) for radiologic assessment of response (RaR), to define the spectrum of treatment response among patients with muscle invasive bladder cancer (MIBC). Methods Ten consecutive patients diagnosed with non-metastatic MIBC were prospectively enrolled and addressed to NAC and underwent mpMRI before staging resection and after the chemotherapy cycles. The follow-up MRI assessment was performed using the nacVI-RADS algorithm for evaluation of response to therapy. NacVI-RADS categorically define complete RaR, based on prior VI-RADS score, presence of residual disease, tumor size, and infiltration of the muscularis propria. Results NacVI-RADS categories were able to match all the final radical cystectomy pathology both for complete pT0 responders and for the patients defined as partial or minimal responders, who only showed some RaR inter-scoring class downstaging. Conclusion This report is the preliminary evidence of the feasibility of nacVI-RADS criteria. These findings might lead to possible paradigmatic shifts for cancer-specific survival risk assessment and to possibly drive the therapeutic decision through active surveillance programs, bladder-sparing modalities, or to the standard of care.

Comparison between biparametric and multiparametric MRI in predicting muscle invasion by bladder cancer based on the VI-RADS

“…Furthermore, MRI based on VI-RADS has the perspective applicability to be broadly used for follow-up in patients with BCa 23 . Two potential applications of MRI based on VI-RADS are assessment of responses to systematic therapy and risk assessment 24 and active surveillance. Active surveillance may be considered in patients with low risk NMIBC 25 .…”

The use of MRI in urothelial carcinoma

“…Preliminary evidence has suggested that nacVI-RADS categories correctly described the final radical cystectomy pathological findings, both for complete responders (pT0) and for patients defined as partial or minimal responders. Consequently, nacVI-RADS proved to accurately predict the response to therapy [5 ▪▪ ,56]. This evidence may have implications for BCa management and could suggest addressing specific patients with active surveillance, bladder sparing procedures or radical cystectomy.…”

Nuevas herramientas para el diagnóstico del cáncer de vejiga

“…Figura 4. Esquematización de la anatomía de la pared vesical y respectivas imágenes de resonancia magnética en imágenes T2W, DWI, ADC y DCE [51]. DWI may show a thickened hypointense line representing edematous mucosa.…”

“…En un estudio similar 231 pacientes sometidos a RMmp para discriminar TMI y TNMI antes de Re-RTUV, logrando una sensibilidad, especificidad y AUC del 91.9%, 91.1% y 0.94 respectivamente. (46) Un metaanálisis que incluyó 1770 pacientes, (51) con una sensibilidad y especificidad agrupadas de 0.83 (IC 95% 0.70-0.90) y 0.90 (IC 0.83-0.95) con un área bajo de curva de ROC de 94% para la detección de lesiones que comprometen el detrusor, sin embargo, el análisis mostraba una alta heterogeneidad entre los estudios. Un metaanálisis más reciente, que incluyó 22 estudios y 5414 reportes de RNMmp, con una AUC 0.93 y con una sensibilidad de 89% y especificidad del 84% para detectar TMI lo que vuelve al VI-RADS una herramienta altamente precisa.…”

“…Normal muscularis propria shows low SI on T2W images and no early enhancement at DCE MRI. Visualization of different muscular layers is difficult to achieve, but can be seen as low T2 SI of the innermost muscular layer (muscularis propria) and intermediate intensity in the outer part[51].…”