Diagnostic accuracy and reliability of VI-RADS in assessing muscle invasion in bladder cancer: Insight from a prospective tertiary care study.

BACKGROUND

Multiparametric magnetic resonance imaging (mp-MRI) has emerged as a promising technique for evaluating the extent of bladder cancer, particularly for assessing muscle invasion. The Vesical Imaging Reporting and Data System (VI-RADS), introduced in 2018, aims to standardize the interpretation of mp-MRI for staging bladder tumors. This study investigates the diagnostic accuracy of VI-RADS in predicting detrusor muscle involvement preoperatively.

OBJECTIVE

To assess the diagnostic performance of VI-RADS scoring in determining muscle invasion in bladder cancer patients prior to surgical intervention.

METHODS

This prospective study enrolled 62 patients between June 2021 and April 2023 who presented with bladder masses. Each underwent mp-MRI followed by surgical treatment, including either TURBT or radical cystectomy. Two radiologists independently evaluated images using VI-RADS scoring. The results were compared with final histopathological findings to determine diagnostic accuracy.

RESULTS

VI-RADS scores of 4 and 5 were observed in 10 (16%) and 19 (30.6%) patients respectively; scores of 3, 2, and 1 were assigned to 3 (4.8%), 25 (40.3%), and 5 (8.0%) patients, respectively. Histopathological evaluation confirmed muscle invasion in 29 patients (46.77%) and non-muscle-invasive disease in 33 (53.22%). The mp-MRI demonstrated a sensitivity of 93.10%, specificity of 93.94%, and an overall accuracy of 93.54% in detecting muscle invasion.

CONCLUSION

Mp-MRI interpreted using the VI-RADS system offers more than 90% sensitivity and specificity for detecting muscle invasion in bladder cancer. VI-RADS may serves as a valuable tool for preoperative staging, potentially optimizing treatment planning and reducing unnecessary restaging TURBT.