European journal of radiology · 2026
Diagnostic performance of post-chemoradiotherapy nacVI-RADS for identifying pathological complete response in muscle-invasive bladder cancer.
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Fukui Kenichi, Kobayashi Masaki, Yoshida Soichiro, Arita Yuki, Yamagiwa Ken, Tsuchiya Junichi, Fujiwara Motohiro, Aslan Serdar, Tasdemir Merve Nur, Fujii Yasuhisa, Tateishi Ukihide
Аннотация
OBJECTIVES: To evaluate whether post-chemoradiotherapy neoadjuvant chemotherapy Vesical Imaging-Reporting and Data System (nacVI-RADS) is associated with pathological complete response (pCR), and to assess its diagnostic performance and inter-reader agreement in patients with muscle-invasive bladder cancer (MIBC).
MATERIALS AND METHODS: This retrospective study included 73 patients with non-metastatic cT2-4aN0-2 M0 bladder cancer who underwent cisplatin-based chemoradiotherapy followed by radical or partial cystectomy between 2009 and 2024. Two radiologists independently assigned post-chemoradiotherapy nacVI-RADS scores on MRI. For the primary diagnostic analysis, scores were dichotomized as < 3 and ≥ 3. The reference standard was bladder pCR, defined as ypT0 on pathological assessment.
RESULTS: pCR was achieved in 46 of 73 patients (63%). The pCR rate was higher among patients with nacVI-RADS < 3 than among those with nacVI-RADS ≥ 3 for both readers (reader 1: 77% vs. 39%, p = 0.002; reader 2: 74% vs. 39%, p = 0.008). The sensitivity and specificity of nacVI-RADS < 3 for identifying pCR were 78% and 59% for reader 1 and 80% and 52% for reader 2, respectively. Inter-reader agreement was excellent (κ = 0.845; 95% CI, 0.687-0.962).
CONCLUSION: Post-chemoradiotherapy nacVI-RADS < 3 was associated with pCR and showed moderate diagnostic performance with excellent inter-reader agreement in patients with MIBC. Post-chemoradiotherapy nacVI-RADS may provide useful complementary information for response assessment. Larger prospective multicenter studies are warranted to validate these findings.
MATERIALS AND METHODS: This retrospective study included 73 patients with non-metastatic cT2-4aN0-2 M0 bladder cancer who underwent cisplatin-based chemoradiotherapy followed by radical or partial cystectomy between 2009 and 2024. Two radiologists independently assigned post-chemoradiotherapy nacVI-RADS scores on MRI. For the primary diagnostic analysis, scores were dichotomized as < 3 and ≥ 3. The reference standard was bladder pCR, defined as ypT0 on pathological assessment.
RESULTS: pCR was achieved in 46 of 73 patients (63%). The pCR rate was higher among patients with nacVI-RADS < 3 than among those with nacVI-RADS ≥ 3 for both readers (reader 1: 77% vs. 39%, p = 0.002; reader 2: 74% vs. 39%, p = 0.008). The sensitivity and specificity of nacVI-RADS < 3 for identifying pCR were 78% and 59% for reader 1 and 80% and 52% for reader 2, respectively. Inter-reader agreement was excellent (κ = 0.845; 95% CI, 0.687-0.962).
CONCLUSION: Post-chemoradiotherapy nacVI-RADS < 3 was associated with pCR and showed moderate diagnostic performance with excellent inter-reader agreement in patients with MIBC. Post-chemoradiotherapy nacVI-RADS may provide useful complementary information for response assessment. Larger prospective multicenter studies are warranted to validate these findings.