Perspective on the integration of radiomics and spatial omics in the analysis of the tumor microenvironment of bladder cancer and prospects for precision diagnosis and treatment.

Bladder cancer, a common malignant tumor of the urinary system, possesses a highly heterogeneous tumor immune microenvironment that critically influences disease progression, treatment response, and patient prognosis. The limitations of traditional tissue biopsies have spurred interest in non-invasive, dynamic, and spatially resolved assessment strategies. Radiomics enables non-invasive quantification of macroscopic tumor phenotypes through high-throughput extraction of medical imaging features, while spatial omics technologies, such as single-cell and spatial transcriptomics, reveal the fine-grained spatial architecture of cellular and molecular components within the tumor microenvironment. This review systematically summarizes recent advances in radiomics and spatial omics for characterizing the bladder cancer immune microenvironment, with a focus on their synergistic applications in elucidating immune cell spatial distribution, stromal heterogeneity, immune checkpoint expression, and therapy response prediction. Furthermore, we critically examine the current challenges in multi-omics data integration, model generalization, and clinical translation, and outline future directions driven by artificial intelligence, including multimodal fusion, dynamic monitoring, and personalized therapeutic strategies. This review aims to provide a theoretical foundation and technical outlook for precision medicine in bladder cancer, facilitating the translation of imaging-spatial omics from basic research to clinical practice.