Vesical Imaging-Reporting And Data System Research Articles

PD42-06 THE ACCURACY OF VESICAL IMAGING-REPORTING AND DATA SYSTEM (VI-RADS): AN UPDATED COMPREHENSIVE MULTI-INSTITUTIONAL, MULTI-READERS SYSTEMATIC REVIEW AND META-ANALYSIS FROM DIAGNOSTIC EVIDENCE INTO FUTURE CLINICAL RECOMMENDATIONS

You have accessJournal of UrologyCME1 May 2022PD42-06 THE ACCURACY OF VESICAL IMAGING-REPORTING AND DATA SYSTEM (VI-RADS): AN UPDATED COMPREHENSIVE MULTI-INSTITUTIONAL, MULTI-READERS SYSTEMATIC REVIEW AND META-ANALYSIS FROM DIAGNOSTIC EVIDENCE INTO FUTURE CLINICAL RECOMMENDATIONS Francesco Del Giudice, Rocco Simone Flammia, Martina Pecoraro, Marco Moschini, David D'Andrea, Benjamin I. Chung, Lucia Martina Pisciotti, Alessandro Sciarra, Ettore De Berardinis, and Valeria Panebianco Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Martina PecoraroMartina Pecoraro More articles by this author , Marco MoschiniMarco Moschini More articles by this author , David D'AndreaDavid D'Andrea More articles by this author , Benjamin I. ChungBenjamin I. Chung More articles by this author , Lucia Martina PisciottiLucia Martina Pisciotti More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Ettore De BerardinisEttore De Berardinis More articles by this author , and Valeria PanebiancoValeria Panebianco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002603.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to determine through a comprehensive systematic review and meta-analysis the cumulative diagnostic performance of Vesical Imaging-Reporting and Data System (VIRADS) to predict preoperative muscle-invasiveness among different institutions, readers, and optimal scoring accuracy thresholds. METHODS: PubMed, Cochrane and Embase were searched from inception up to May 2021. Sensitivity (Sn), Specificity (Sp), were firstly estimated and subsequently pooled using hierarchical summary receiver operating characteristics (HSROC) modeling for both cut-off ≥3 and ≥4 to predict muscle-invasive bladder cancer (MIBC). Further sensitivity analysis, subgroup analysis and meta-regression were conducted to investigate contribution of moderators to heterogeneity. RESULTS: In total, n=20 studies from 2019 to 2021 with n=2477 patients by n=53 genitourinary radiologists met the inclusion criteria. Pooled weighted Sn and Sp were 0.87 (95%CI: 0.82–0.91) and 0.86 (95%CI: 0.80–0.90) for cut-off ≥3 while 0.78 (95%CI: 0.74–0.81) and 0.94 (95%CI: 0.91–0.96) for cut-off ≥4. The area under the HSROC curve was 0.93 (95%CI: 0.90–0.95) and 0.91 (95%CI: 0.88-0.93) for cut-off ≥3 and ≥4 respectively. Meta-regression analyses showed no influence of clinical characteristics nor cumulative reader’s experience while study design and radiological characteristics were found to influence the estimated outcome. CONCLUSIONS: We demonstrated excellent worldwide diagnostic performance of VI-RADS to determine pre-trans urethral resection of bladder tumor (TURBT) staging. Our findings corroborate wide reliability of VI-RADS accuracy also between different centers with varying experience underling the importance that standardization and reproducibility of VI-RADS may confer to multiparametric magnetic resonance imaging (mpMRI) for preoperative BCa discrimination. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e697 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Del Giudice More articles by this author Rocco Simone Flammia More articles by this author Martina Pecoraro More articles by this author Marco Moschini More articles by this author David D'Andrea More articles by this author Benjamin I. Chung More articles by this author Lucia Martina Pisciotti More articles by this author Alessandro Sciarra More articles by this author Ettore De Berardinis More articles by this author Valeria Panebianco More articles by this author Expand All Advertisement PDF DownloadLoading ...

Biparametric magnetic resonance imaging assessment for detection of muscle-invasive bladder cancer: a systematic review and meta-analysis.

To investigate if removing DCE from the Vesical Imaging Reporting and Data System (VI-RADS) influences the diagnostic accuracy of muscle-invasive bladder cancer (MIBC). We also explored using different reference standards on the MRI diagnostic performance. We searched the Cochrane Library, Embase, and PubMed databases to June 26, 2021. Pooled biparametric MRI (bpMRI, T2WI+DWI) and multiparametric MRI (mpMRI, T2WI+DWI+DCE) sensitivities and specificities and the diagnostic performances of these methods for MIBC were compared using different reference standards. Seventeen studies with 2344 patients were finally included, of which 7 studies, including 1041 patients, reported the diagnostic performance of bpMRI. VI-RADS showed sensitivities and specificities of 0.91 (95% CI 0.87-0.94) and 0.86 (95% CI 0.77-0.91) at cutoff scores of 3, and 0.85 (95% CI 0.77-0.90) and 0.93 (95% CI 0.89-0.96) at cutoff scores of 4. BpMRI showed sensitivities and specificities of 0.90 (95% CI 0.69-0.97) and 0.90 (95% CI 0.81-0.95), and 0.84 (95% CI 0.78-0.88) and 0.97 (95% CI 0.87-0.99), respectively, for cutoff scores of 3 and 4. The sensitivities of bpMRI vs mpMRI for MIBC were not significantly different, but bpMRI was more specific than mpMRI at cutoff scores of 3 (p = 0.02) and 4 (p = 0.02). The VI-RADS studies using primary transurethral resection of bladder tumors (TURBT) as the reference standard had significantly higher sensitivities (p < 0.001) than those using secondary TURBT or radical cystectomy as the reference. BpMRI and conventional VI-RADS had similar diagnostic efficacies for MIBC. Since MRI overestimated MIBC diagnoses using primary TURBT as the reference standard, we recommend using secondary TURBT as the reference standard. • Biparametric MRI without DCE had similar diagnostic efficacies for MIBC compared with conventional VI-RADS. • The sensitivity of VI-RADS was overestimated when referring to the primary TURBT results. • Biparametric MRI comprised of T2WI and DWI could be used for detecting MIBC in clinical practice.

Diagnostic accuracy and discriminative power of biparametric versus multiparametric MRI in predicting muscle-invasive bladder cancer

PurposeInvestigate and compare the diagnostic accuracy and discriminative power of biparametric MRI (bp-MRI) and multiparametric MRI (mp-MRI) in predicting muscle-invasive bladder cancer (MIBC) based on Vesical Imaging-Reporting and Data System (VI‐RADS) scoring and evaluate potentially influencing factors on both protocols’ accuracy. MethodThis retrospective study included 54 bladder cancer (BC) patients who underwent bladder MRI and histo-pathological assessment. Three readers independently reviewed the MRI studies and assigned a 1–5 score for T2-weighted, diffusion-weighted, and dynamic contrast-enhanced images. Then, bp-MRI and mp-MRI final VI-RADS scores were recorded for each BC. Diagnostic tables, chi-square test, kappa score (k), logistic regression, receiver operating characteristics (ROC) curves, areas under the curves (AUCs), and VI-RADS cut-off values were calculated. A Delong test was performed for ROC curve comparison. A P-value<0.05 was considered significant. ResultsIn predicting MIBC, bp-MRI and mp-MRI had comparable diagnostic accuracy with insignificant differences for the three readers (P = 0.364,0.718,0.702). Radiologists’ experience, and tumors’ size and morphology had insignificant effect on bp-MRI accuracy (P = 0.086, 0.392,0.294), respectively. Tumors’ size significantly influenced mp-MRI accuracy (P = 0.039). Bp-MRI and mp-MRI had comparable discriminative power with insignificant differences for all readers (P > 0.05). Using VI-RADS > 3 cut-off value improved the discriminative power of bp-MRI. Excellent inter-reader agreement in VI-RADS scoring for bp-MRI (k range, 0.814–0.867) and mp-MRI (k range, 0.787–0.859) was observed. ConclusionBp-MRI and mp-MRI demonstrated comparable diagnostic accuracy and discriminative power in predicting MIBC. The accuracy of bp-MRI was not influenced by radiologists’ experience, or tumors’ size and morphology.

Conspicuity and muscle-invasiveness assessment for bladder cancer using VI-RADS: a multi-reader, contrast-free MRI study to determine optimal b-values for diffusion-weighted imaging

ObjectiveTo (1) compare bladder cancer (BC) muscle invasiveness among three b-values using a contrast-free approach based on Vesical Imaging-Reporting and Data System (VI-RADS), to (2) determine if muscle-invasiveness assessment is affected by the reader experience, and to (3) compare BC conspicuity among three b-values, qualitatively and quantitatively.MethodsThirty-eight patients who underwent a bladder MRI on a 3.0-T scanner were enrolled. The gold standard was histopathology report following transurethral resection of BC. Three sets of images, including T2w and different b-values for DWI, set 1 (b = 1000 s/mm2), set 2 (b = 1500 s/mm2), and set 3 (b = 2000 s/mm2), were reviewed by three differently experienced readers. Descriptive statistics and Intraclass Correlation Coefficient (ICC) were calculated. Comparisons among readers and DWI sets were performed with the Wilcoxon test. Receiver operating characteristic (ROC) analysis was performed. Areas under the curves (AUCs) and pairwise comparison were calculated.ResultsAUCs of muscle-invasiveness assessment ranged from 0.896 to 0.984 (reader 1), 0.952–0.968 (reader 2), and 0.952–0.984 (reader 3) without significant differences among different sets and readers (p > 0.05). The mean conspicuity qualitative scores were higher in Set 1 (2.21–2.33), followed by Set 2 (2–2.16) and Set 3 (1.82–2.14). The quantitative conspicuity assessment showed that mean normalized intensity of tumor was significantly higher in Set 2 (4.217–4.737) than in Set 1 (3.923–4.492) and Set 3 (3.833–3.992) (p < 0.05).ConclusionMuscle invasiveness can be assessed with high accuracy using a contrast-free protocol with T2W and DWI, regardless of reader’s experience. b = 1500 s/mm2 showed the best tumor delineation, while b = 1000 s/mm2 allowed for better tumor–wall interface assessment.

IJU this Issue

This issue of International Journal of Urology contains one Review Article, 10 Original Articles, and eight editorial comments. Yuan et al. (Jiangsu, China) updated a meta-analysis for the diagnostic performance of the Vesical Imaging–Reporting And Data System (VI-RADS) for predicting muscle-invasive bladder cancer (MIBC) with 20 studies published between September 2018 and July 2021. VI-RADS was introduced in 2018 to define a standardized approach to imaging and reporting multiparametric magnetic resonance imaging for patients with bladder cancer. The diagnostic performance of the VI-RADS for predicting MIBC was excellent in both cutoff points of the VI-RADS 3 and 4. Multiple image acquisition planes of diffusion-weighted imaging should be given more attention in the VI-RADS. We hope that VI-RADS will become more mature and prevalent, which should lead to better management of bladder cancer via further studies. In the original articles, Nishimura et al. (Nara, Japan) evaluated the clinical outcomes and prognostic factors in Japanese patients with bacillus Calmette-Guerin (BCG)-unresponsive nonmuscle-invasive bladder cancer (NMIBC) who underwent early radical cystectomy (RC) using a large-scale multicenter retrospective study and concluded the highest-risk status among the pre-BCG factors was associated with upstaging to extravesical tumors and poor prognosis, despite early RC procedures. The Japanese Urological Association Clinical Practice Guidelines for Bladder Cancer 2019 recommended that patients with BCG-unresponsive disease are considered unlikely to benefit from further BCG therapy and early RC. This study seems to be one of those with the evidence based on a pathological evaluation. Although some new strategies such as intravesical nadofargene firadenovec gene therapy (Lancet Oncol. 2021; 22: 107–17), pembrolizumab monotherapy (Lancet Oncol. 2021; 22: 919–30) have been reported, there is no doubt that BCG-unresponsive disease is a risk factor and RC will continue to be required in a certain proportion of patients with BCG-unresponsive NMIBC. Kato et al. (Osaka, Japan) evaluated the long-term incidence and clinical features of post-transplant lymphoproliferative disorders (PTLD) in kidney transplant recipients from two major transplantation centers in Japan. Graft survival has improved due to a reduction in the acute rejection rate by advances in immunosuppressive agents; however long-term survival after kidney transplantation remains unchanged. Therefore, it is extremely important to focus on malignancy, especially PTLD after kidney transplantation. They emphasized the strategies to identify PTLD and suggested the benefits of positron emission tomography-computed tomography for ascertaining PTLD. They also revealed that mycophenolate mofetil contributed the onset of PTLD, and rituximab was not significantly associated with the incidence of PTLD. We have to be careful for each immunosuppressive agent. Yamashita et al. (Shizuoka, Japan) examined the incidence and location of lower extremity deep vein thrombosis (DVT) in patients undergoing RC. Venous thromboembolism (VTE) including DVT and pulmonary embolism is a serious perioperative complication in urological surgery. RC, whether open or robot-assisted surgery, is the procedure with the highest risk of perioperative VTE in urological surgery according to the European Association of Urology (EAU) guidelines on thromboprophylaxis in urological surgery. They also identified that preoperative D-dimer level was a significant risk factor for preoperative DVT, and preoperative D-dimer level, type of urinary diversion (ileal neobladder), and preoperative DVT were significant risk factors for postoperative DVT. EAU guidelines strongly recommended the use of pharmacological prophylaxis in all patients undergoing open and robot-assisted RC. These results might suggest appropriate patients for pharmacological prophylaxis in RC. Unfortunately, the limited space does not allow me to introduce all the articles. However, all the papers are very interesting and informative. Please enjoy this issue of the International Journal of Urology. None declared.

Plasmacytoid urothelial carcinoma of the bladder: MRI features and their association with survival.

Plasmacytoid urothelial carcinomas (PUC) of the bladder are rare variants known for diffuse and infiltrative spread, however their magnetic resonance imaging (MRI) features are not well established. We aimed to evaluate MRI features of PUC of the bladder and their association with survival. This retrospective single-center study included 41 patients with pathologically-proven bladder PUC of the bladder that underwent pre-treatment MRI between January 2000 and March 2020. Two radiologists reviewed MRIs independently followed by consensus with a third radiologist. On MRI, tumor extent, size, Vesical Imaging-Reporting and Data System (VI-RADS) scores (≥4, muscle-invasive; 5, extravesical extension [EVE]), pelvic peritoneal spread (PPS), hydronephrosis, pelvic adenopathy and clinicopathological factors of age, gender, pathological stage, and treatment type were extracted. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with survival. Thirty-two men and 9 women (median age 70 years, IQR 64-76) were included. Most were muscle-invasive (n = 30 [73.2%]). On MRI, most tumors were diffuse (n = 28 [68.3%]), >5 cm (n = 30 [73.2%]), VI-RADS 4 to 5 (n = 36 [87.8%]) with features of EVE and (n = 31 [75.6%]) and PPS (n = 25 [61.0%]). Variables associated with survival were: Larger tumors (>5 cm; hazard ratio [HR] = 5.0; 95% confidence interval [CI] 1.6-15.5; P < 0.01), diffuse extent (HR = 4.0; 95% CI 1.4-11.2; P = 0.01), EVE (HR = 4.5; 95% CI 1.5-13.6; P < 0.01), PPS (HR = 3.0; 95% CI 1.2-7.4; P = 0.01), hydronephrosis (HR = 13.7; 95% CI 3.1-60.9; P < 0.01), pathologic stage (≥pT3 vs. pT1; HR = 5.6; 95% CI 1.3-22.0; P = 0.02), and margin positivity (HR = 4.4 [95% CI 1.2-16.4], P = 0.03). PUCs of the bladder are commonly large, diffuse VI-RADS score 4 to 5 tumors with MRI features of EVE and PPS. These features and pathological stage were associated with survival.

Diagnostic accuracy of vesical imaging-reporting and data system (VI-RADS) for the detection of muscle-invasive bladder cancer: a meta-analysis.

Vesical Imaging-Reporting and Data System (VI-RADS) was proposed and considered as a standardized reporting criterion for bladdermagnetic resonance imaging (MRI). VI-RADS could suggest the likelihood of muscle invasion based on themultiparametric MRI (mp-MRI) findings which contain five-point scores. The current study is designed to comprehensively and systematically evaluate the diagnostic performance of VI-RADS (score 3 and 4) for predicting muscle invasion. The Cochrane Library, Embase, and PubMed were searched comprehensively from inception to October 2021. Finally, 19 studies incorporating 2900 patients were enrolled. The pooled sensitivity and specificity of VI-RADS 3 for predicting muscle invasion were 0.92 (95%CI 0.89-0.94) and 0.82 (95%CI 0.76-0.87), respectively. The pooled sensitivity and specificity of VI-RADS 4 were 0.78 (95%CI 0.72-0.83) and 0.96 (95%CI 0.93-0.97), respectively. And the area under the curve (AUCs) of VI-RADS 3 and 4 were all 0.94 (95%CI 0.92-0.96). No significant publication biases were not observed for VI-RADS 3 (P = 0.74) and 4 (P = 0.57). The VI-RADS reveals a good diagnostic performance for predicting muscle invasive in bladder cancer, which also has good clinical utilities and applicability. And VI-RADS 3 and 4 as cutoff values provide similar overall diagnostic and could be selectively applied individually. Prospective studies with a large scale are further required to validate the accuracy of the VI-RADS score.

Diagnostic accuracy of vesical imaging-reporting and data system (VI-RADS) in suspected muscle invasive bladder cancer: A systematic review and diagnostic meta-analysis.

To investigate the accuracy of Vesical Imaging-Reporting and Data System (VI-RADS) in detection of muscle-invasive bladder cancer (MIBC) we performed a systematic review and meta-analysis of the available literature. Scopus, Web of Science, PubMed, and EMBASE were searched up to 8 March 2021 for the studies evaluating the diagnostic performance of VI-RADS for the detection of MIBC. Inclusion criteria were patients with bladder cancer; index test of VI-RADS based on multiparametric MRI; reference test of histopathological findings from TURBT, re-TURBT, or cystectomy and study design of cohort. Case reports, review articles, and editorials were eliminated, as well as studies with insufficient knowledge to acquire TP, FP, FN, and TN values of VI-RADS. The MIDAS module of STATA was for statistical analysis. The heterogeneity was explored using subgroup analysis and meta-regression analysis. Overall, 22 eligible studies, consisting of 2,576 participants and 5,414 MRI reports, were included in this meta-analysis. The area under curve (AUC) of VI-RADS at cut-point values of 3 and 4 were 0.93 (95%CI: 0.91, 0.95), 0.93 (95%CI: 0.90, 0.95), respectively. Based on Youden's J statistic, the optimal VI-RADS cutoff value for predicting MIBC was determined as 3 which granted a pooled sensitivity of 89% (95%CI: 87%, 91%; I2=48%) and a specificity of 84% (95%CI: 80%, 87%; I2=90%). Based on meta-regression, the sources of inter-study heterogeneity for VI-RADS ≥ 3 were the sample size > 70, study design, single-center vs multi-center, patient population characteristics (i.e., gender, age), reference standard, histology, magnetic strength, T2WI slice thickness, and the number of radiologists reporting the MRI results (P value ≤ 0.01). The VI-RADS demonstrates consistently high diagnostic accuracy to predict MIBC. This scoring system could be applied in standard staging MRI reports of bladder cancer and can be incorporated into future MIBC work up guidelines.

Diagnostic performance of the vesical imaging-reporting and data system for detecting muscle-invasive bladder cancer in real clinical settings: Comparison with diagnostic cystoscopy.

We herein compared the diagnostic performance of Vesical Imaging-Reporting and Data System (VI-RADS) scoring with diagnostic cystoscopy and evaluated diagnostic accuracies based on tumor locations. Among 112 bladder cancer patients who underwent multiparametric magnetic resonance imaging and diagnostic cystoscopy preoperatively to detect bladder cancer, 61 were analyzed. VI-RADS was categorized into 5 stages by 2 radiologists (R1 and R2). Cut-off values ≥3 indicated muscle-invasive bladder cancer (MIBC). Muscle invasion (MI) was visually evaluated using diagnostic cystoscopy by 2 urologists (U1 and U2). The sensitivity and specificity of VI-RADS scores and diagnostic cystoscopy for diagnosing MI were compared. 16 patients (26.2%) were pathologically diagnosed with MIBC. Regarding MI diagnostic accuracy, the sensitivity/specificity of VI-RADS scores were 93.8/88.9% by R1 and 87.5/86.7% by R2, while those of diagnostic cystoscopy were 56.3/68.9% by U1 and 68.8/84.4% by U2. Therefore, the diagnostic accuracy of VI-RADS was significantly higher than that of cystoscopy, particularly for tumors located on the bladder neck, trigone, dome, and posterior and anterior walls. Over- and under-diagnosis rates were higher with VI-RADS than with diagnostic cystoscopy (25.9% vs. 14.8%) for tumors located on the lateral wall or ureteral orifice. VI-RADS had superior diagnostic performance for detecting MI, especially in tumors located at the bladder neck/trigone/dome/posterior and anterior wall. However, VI-RADS was inferior to cystoscopy in terms of MI detection for tumors located on the lateral wall or ureteral orifice. Therefore, a combination of diagnostic tools is recommended for the accurate staging of these tumors.

Accuracy and Challenges in the Vesical Imaging-Reporting and Data System for Staging Bladder Cancer.

The Vesical Imaging-Reporting and Data System (VI-RADS) scoring system has been widely used to stage bladder cancer (BCa) since 2018. To describe the characteristics of cases with discordant T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) scores in patients with BCa and further verify the accuracy of the VI-RADS scoring system and the necessity of dynamic contrast-enhanced (DCE) sequence. Retrospective. A total of 106 patients (include 16.5% female) with bladder cancer. T2WI (fast spin echo), DWI (echo planer imaging), and DCE (gradient echo). Some cases are difficult to score according to the system, mainly when the T2WI (category 4) and DWI (category 2) sequence scores are discordant, termed the discordant group below. The complementary group will be termed concordant group. Each MRI sequence was reviewed respectively according to the 5-point VI-RADS scoring system by three observers. The diagnostic ability of sequences for evaluating muscle invasion by BCa was calculated using histopathology as the reference standards. Receiver operating characteristic (ROC) curve, DeLong test, intraclass correlation coefficient. A P value of 0.05 or less was considered statistically significant. Fourteen cases (13.2%) had discordant VI-RADS scoring system. In the discordant group, the area under the ROC curve (AUC) of DCE was 0.875, while the T2WI and DWI showed limited diagnostic performance (AUCs=0.50). In the concordant group, there was no significant difference in diagnostic efficacy between the overall VI-RADS (AUC: 0.950) and the combination of T2WI and DWI (AUC: 0.946) (P=0.56). Among all patients, the AUC of overall VIRADS was 0.939 with a 3 or greater cutoff value. The DCE was crucial in the discordant group for evaluating muscle-invasiveness, while DCE may not be necessary for the concordant group. The VI-RADS scoring system performed with overall good diagnostic performance in evaluating muscle-invasiveness in BCa patients. 4 TECHNICAL EFFICACY: Stage 3.

VESICAL IMAGING-REPORTING AND DATA SYSTEM - A NEW APPROACH TO BLADDER CANCER STAGING.

The aim: To present the assumptions and to show the usefulness of Vesical Imaging-Reporting and Data System (VI-RADS) based on multiparametric magnetic resonance imaging (mpMRI) in the diagnostic pathway management of patients with a bladder cancer. Materials and methods: The review is based on available literature from last 10 years from PubMed database and the Przegląd Urologiczny journal focusing on articles on VI-RADS. Overall, 18 articles were included. Presented magnetic resonance images come from the examinations of the patients who were diagnosed with bladder cancer from 2019 to 2021 at Department of Diagnostic Imaging in University Clinical Hospital in Opole, Poland. Conclusions: The newly developed Vesical Imaging-Reporting and Data System has a potential to play a significant role in staging of the bladder cancer as a non-invasive, comprehensive, and effective diagnostic tool providing accurate information for differentiation non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC). However more prospective studies should be conducted to validate this system in clinical practice.

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

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). 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. 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. 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.

Diagnostic benefit of multiparametric MRI over contrast-enhanced CT in patients with bladder cancer: A single-center 1-year experience

PurposeTo assess the clinical applicability of local tumor staging in urinary bladder cancer (BC) with preoperative multiparametric MRI (mpMRI) using the five-point Vesical Imaging-Reporting and Data System (VI-RADS) scoring system and to compare it to dual-phase contrast-enhanced computed tomography (CECT). Methods33 patients with primary untreated bladder cancer underwent CECT followed by preoperative multiparametric 3.0 T MRI between July 2019 and August 2020 and were enrolled in this retrospective study. Two radiologists initially performed staging on the CECT image data sets and - blinded to CT results - on subsequent mpMRI. BCs were staged according to the VI-RADS scoring system. Postoperative pathology was correlated to the VI-RADS score and the CECT results. The performance of VI-RADS in determining detrusor muscle invasion was analyzed using a receiver operating characteristic curve. Based on the histopathology, sensitivity, specificity and accuracy for muscle invasiveness between both image modalities were compared using the Chi square test. ResultsA total of 33 patients (29 male, median age 70 years, IQR: 59–81 years) were included. 10 tumors were categorized as non-muscle invasive (30%) and 23 as muscle invasive BC (70%) in final histology. Tumor stages were correctly assigned as being either muscle invasive or non-muscle invasive on both CECT and mpMRI with regard to both early and late stages of BC (Ta-Tis and T3a-T4b). T-stages bordering the histopathologic limits of muscle invasiveness (T1-T2a-b) resulted in overestimation of muscle invasion in 43% of cases (VI-RADS 3–4) for the mpMRI image data sets and in an underestimation of muscle invasion in up to 55.5% of cases analysing the CECT data. Sensitivity and specificity for the determination of muscle invasion in CECT and mpMRI were 80%/80% and 74%/61% for Radiologist#1 and 70%/90% and 83%/70% for Radiologist#2, respectively. ConclusionsThere are advantages and disadvantages of both CECT and mpMRI when used in the clinical assessment of BC muscular tumor invasion. In borderline cases, only the combination of cross-sectional imaging and histopathological staging may help in making the optimal treatment decisions.

Accuracy of the Vesical Imaging-Reporting and Data System (VIRADS) for pre-treatment staging of bladder cancer in an Australian cohort.

To evaluate the performance of the Vesical Imaging-Reporting and Data System (VIRADS) in differentiating muscle-invasive and non-muscle-invasive bladder cancer and whether this reporting system improves inter-reader agreement. Sixty-four cases of multiparametric 3 tesla bladder MRI from January 2014 to May 2020 were reviewed retrospectively. T2-weighted, diffusion and post-contrast images were reviewed. All magnetic resonance images were reported by a radiologist with 15 years' experience (Reader 1) and a final year radiology trainee with a special interest in urogenital imaging with 3 years of experience (Reader 2). Both readers were blinded to clinical history and histopathology results when scoring each lesion. The sensitivity and specificity for differentiating MIBC and NMIBC were 91% and 68%, respectively, for Reader 1 and 91% and 63%, respectively, for Reader 2. The inter-reader agreement for assigning VIRADS scores was 0.79. The area under the receiver operator curve for Reader 1 and 2 were not significantly different (Reader 1 = 0.79, Reader 2 = 0.77, P = 0.83). Staging of bladder cancer prior to treatment can be accurately and reliably diagnosed using VIRADS, a novel, standardised reporting system for bladder MRI.

Visual MRI T-category versus VI-RADS evaluation from multiparametric MRI in the detection of muscle-invasion in patients with suspected bladder cancer: single centre registered clinical trial (MIB-trial)

Background Multiparametric Magnetic Resonance Imaging (mpMRI) has been proposed to add value in the diagnostic pathway of bladder cancer (BC). We wanted to evaluate the performance of mpMRI for muscle-invasion detection in BC patients using a subjective MRI visual T-category and the Vesical Imaging-Reporting and Data System (VI-RADS) score. Methods This single centre clinical trial included 45 patients with suspected BC (ClinicalTrials.gov Identifier: NCT02662166). All patients had mpMRI prior to transurethral resection of bladder tumour (TUR-BT). The imaging was correlated to histopathological findings. Two individual radiologists evaluated all the mpMRI images. A binary cut-off point for the detection of muscle-invasion in the MRI visual T-category was defined between T1 and T2 and the VI-RADS cut-off score was 3. Cohen’s Kappa values were used to evaluate the agreement between the two radiologists. Sensitivity, Specificity, Area Under Receiver Operator Characteristics Curve (AUC), Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated to evaluate the performance of both radiologists separately. Results AUC values for reader A and B using the MRI visual T-category were 0.76 and 0.56, while the corresponding values for VI-RADS were 0.63 and 0.57, respectively. There was no statistically significant difference between the radiologists nor the reporting systems (p > .05) in the detection of muscle-invasion. The inter-reader agreement was substantial (0.61–0.80). Conclusion Both the subjective MRI visual T-category and VI-RADS score had only a low to moderate accuracy for the detection of muscle-invasion in BC with no statistically significant difference between the reporting systems.

Evaluation of a fractional-order calculus diffusion model and bi-parametric VI-RADS for staging and grading bladder urothelial carcinoma.

To evaluate the feasibility of high b-value diffusion-weighted imaging (DWI) for distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) and low- from high-grade bladder urothelial carcinoma using a fractional-order calculus (FROC) model as well as a combination of FROC DWI andbi-parametric Vesical Imaging-Reporting and Data System (VI-RADS). Fifty-eight participants with bladder urothelial carcinoma were included in this IRB-approved prospective study. Diffusion-weighted images, acquired with 16 b-values (0-3600 s/mm2), were analyzed using the FROC model. Three FROC parameters, D, β, and μ, were used for delineating NMIBC from MIBC and fortumor grading. A receiver operating characteristic (ROC) analysis was performed based on the individual FROC parameters and their combinations, followed by comparisons with apparent diffusion coefficient (ADC) and bi-parametric VI-RADS based on T2-weighted images and DWI. D and μ were significantly lower in the MIBC group than in the NMIBC group (p = 0.001 for each), and D, β, and μ all exhibited significantly lower values in the high- than in the low-grade tumors (p ≤ 0.011). The combination of D, β, and μ produced the highest specificity (85%), accuracy (78%), and the area under the ROC curve (AUC, 0.782) for distinguishing NMIBC and MIBC, and the best sensitivity (89%), specificity (86%), accuracy (88%), and AUC (0.892) for tumor grading, all of which outperformed the ADC. The combination of FROC parameters with bi-parametric VI-RADS improved the AUC from 0.859 to 0.931. High b-value DWI with a FROC model is useful in distinguishing NMIBC from MIBC and grading bladder tumors. • Diffusion parameters derived from a FROC diffusion model may differentiate NMIBC from MIBC and low- from high-grade bladder urothelial carcinomas. • Under the condition of a moderate sample size, higher AUCs were achieved by the FROC parameters D (0.842) and μ (0.857) than ADC (0.804) for bladder tumor grading with p ≤ 0.046. • The combination of the three diffusion parameters from the FROC model can improve the specificity over ADC (85% versus 67%, p = 0.031) for distinguishing NMIBC and MIBC and enhance the performance of bi-parametric VI-RADS.

Preliminary Exploration of the Application of Vesical Imaging‐Reporting and Data System (VI‐RADS) in Post‐treatment Patients With Bladder Cancer: A Prospective Single‐Center Study

Vesical Imaging-Reporting and Data System (VI-RADS) has been shown to be effective in diagnosing muscle invasion of bladder cancer (BC) in primary patients. To evaluate the diagnostic efficacy of VI-RADS in a BC target population which included post-treatment patients, and to determine the repeatability. Prospective. Seventy-three patients (42 with primary BC, 31 with post-treatment BC). 3.0 T MRI with propeller fast spin-echo T2 WI, echo planer imaging diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCEI). VI-RADS scores were independently assessed by five radiologists with different levels of experience. The diagnostic efficiency in each group (primary and post-treatment) and of each radiologist was assessed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and area under the curve (AUC) in receiver operating characteristic curve analysis were calculated to evaluate VI-RADS diagnostic performance. Interobserver agreement was assessed using weighted Kappa statistics. A P value <0.05 was considered statistically significant. At the corresponding cut-off, AUC values of three groups range from 0.936 to 0.947 and AUC values of five observers range from 0.901 to 0.963. There was no significant difference between the AUCs in the primary and post-treatment groups (P= 0.870). The cut-off of the whole group and the post-treatment group was ≥4, and the cut-off of the primary group was ≥3. The Kappa values of interobserver agreements range from 0.709 to 0.923. After expanding the target population to include post-treatment patients, VI-RADS still has good diagnostic efficacy and repeatability. VI-RADS could potentially be a preoperative staging tool for post-treatment patients. 1 TECHNICAL EFFICACY STAGE: 2.

Vesical Imaging Reporting and Data System (VI-RADS): Are the individual MRI sequences equivalent in diagnostic performance of high grade NMIBC and MIBC?

PurposeTo investigate the diagnostic performance of the overall Vesical Imaging Reporting and Data System (VI-RADS) score and its individual magnetic resonance imaging (MRI) parameters in assessing grade and muscle invasiveness of bladder cancer (BC). MethodsThis IRB-approved retrospective, single-center, cross-sectional study included patients with BC wo underwent 3 Tesla preoperative multiparametric (mp)-MRI including T2-weighted (T2w), diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) sequences. An independent evaluation according to VI-RADS was performed by two radiologists in separate sessions, blinded to histological findings. ResultsThe mean age of 59 included patients was 68.2 (±13.6 standard deviation) years. Among bladder cancer patients, 26 (51%) were identified as high grade and 14 (27.5%) as muscle invasive urothelial carcinomas in histological sections. The area under the curve (AUC) for the overall VI-RADS score to predict muscle invasion was 0.986 (R1) and 0.992 (R2). The AUC to diagnose high grade bladder cancer was 0.908 (R1) and 0.905 (R2). There was no significance difference between the AUC of single parameters (T2w, DWI and DCE) compared to the total VI-RADS score (P > 0.05, respectively). Upon multivariate logistic regression, only the T2w VI-RADS score contributed independently to the diagnosis of high grade and muscle invasive bladder cancer (P = 0.001 (R1) and P = 0.0022 (R2) for high grade cancer; P = 0.0007 (R1) and P = 0.0019 (R2) for muscle invasiveness). ConclusionVI-RADS provides high diagnostic accuracy to diagnose high grade and muscle invasive BC. Our results suggest, that mp-MRI parameters provide overlapping information and for sake of clinical simplicity, a biparametric, contrast free image acquisition may be approached without sacrificing diagnostic accuracy.

Detecting Muscle Invasion of Bladder Cancer Using a Proposed Magnetic Resonance Imaging Strategy.

Accurate evaluation of the invasion depth of tumors with a Vesical Imaging-Reporting and Data System (VI-RADS) score of 3 is difficult. 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). Single center, retrospective. 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. 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). 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. Intraclass correlation coefficients (ICCs), Mann-Whitney U test, chi-square tests, receiver operating characteristic (ROC) curves, and 2 × 2 contingency tables were applied. 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. The proposed MRI strategy could reduce the false-positive rate of lesions with a VI-RADS score of 3 while retaining sensitivity. 4 TECHNICAL EFFICACY: 2.

Combining Multiparametric MRI Radiomics Signature With the Vesical Imaging-Reporting and Data System (VI-RADS) Score to Preoperatively Differentiate Muscle Invasion of Bladder Cancer.

BackgroundThe treatment and prognosis for muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC) are different. We aimed to construct a nomogram based on the multiparametric MRI (mpMRI) radiomics signature and the Vesical Imaging-Reporting and Data System (VI-RADS) score for the preoperative differentiation of MIBC from NMIBC.MethodThe retrospective study involved 185 pathologically confirmed bladder cancer (BCa) patients (training set: 129 patients, validation set: 56 patients) who received mpMRI before surgery between August 2014 to April 2020. A total of 2,436 radiomics features were quantitatively extracted from the largest lesion located on the axial T2WI and from dynamic contrast-enhancement images. The minimum redundancy maximum relevance (mRMR) algorithm was used for feature screening. The selected features were introduced to construct radiomics signatures using three classifiers, including least absolute shrinkage and selection operator (LASSO), support vector machines (SVM) and random forest (RF) in the training set. The differentiation performances of the three classifiers were evaluated using the area under the curve (AUC) and accuracy. Univariable and multivariable logistic regression were used to develop a nomogram based on the optimal radiomics signature and clinical characteristics. The performance of the radiomics signatures and the nomogram was assessed and validated in the validation set.ResultsCompared to the RF and SVM classifiers, the LASSO classifier had the best capacity for muscle invasive status differentiation in both the training (accuracy: 90.7%, AUC: 0.934) and validation sets (accuracy: 87.5%, AUC: 0.906). Incorporating the radiomics signature and VI-RADS score, the nomogram demonstrated better discrimination and calibration both in the training set (accuracy: 93.0%, AUC: 0.970) and validation set (accuracy: 89.3%, AUC: 0.943). Decision curve analysis showed the clinical usefulness of the nomogram.ConclusionsThe mpMRI radiomics signature may be useful for the preoperative differentiation of muscle-invasive status in BCa. The proposed nomogram integrating the radiomics signature with the VI-RADS score may further increase the differentiation power and improve clinical decision making.