Could Bladder Multiparametric MRI Be Introduced in Routine Clinical Practice? Role of the New VI-RADS Score: Results From a Prospective Study

• Published in: Clinical genitourinary cancer Vol. 18; no. 5; pp. 409 - 415.e1
• Main Authors: Marchioni, Michele, Primiceri, Giulia, Delli Pizzi, Andrea, Basilico, Raffaella, Berardinelli, Francesco, Mincuzzi, Erica, Castellucci, Roberto, Sessa, Barbara, Di Nicola, Marta, Schips, Luigi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020
• Subjects: Bladder cancer; Bladder diagnostic; Multiparametric magnetic resonance imaging of bladder; Muscle invasive bladder cancer; VI-RADS score; Bladder diagnostic; Multiparametric magnetic resonance imaging of bladder; VI-RADS score; Muscle invasive bladder cancer; Bladder cancer
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2020.03.002

The Vesical Imaging Reporting and Data System (VI-RADS) was recently introduced as a standardized approach to reporting multiparametric magnetic resonance imaging (mpMRI) for bladder cancer. We aimed to prospectively analyze its routine use and its diagnostic performance in discriminating non–muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). A total of 38 patients with diagnosis of suspect bladder cancer at cystoscopy underwent bladder mpMRI before transurethral resection of the bladder (TURB). Bladder tumors were categorized according to the VI-RADS. After TURB, the VI-RADS score was compared with histological report for each lesion separately. Receiving operating characteristic and decision curve analyses were used to assess its accuracy and clinical utility. A total of 68 lesions were included, of which 7 (10.3%) were MIBC. The pooled accuracy was 90.0% (95% confidence interval [CI], 75.4%-98.7%). The best threshold was estimated as VI-RADS 4, showing a sensitivity of 85.7% (95% CI, 57.1%-100%) and a specificity of 86.9% (95% CI, 78.7%-95.1%). Decision curve analyses showed that using VI-RADS ≥4 improved the net benefit compared with any default strategy for threshold probabilities of MIBC up to ∼40%, which is a reasonable clinical threshold for planning further treatments. Our prospective study shows that the use of VI-RADS as a standardized reporting method is appealing and could be considered in clinical practice owing to its high accuracy. In the present study, we tested the ability of VI-RADS score to discern MIBC from NMIBC. We found that the VI-RADS score has high accuracy. Thus, its routine use may be appealing.