European Radiology

, Volume 29, Issue 10, pp 5498–5506 | Cite as

Multiparametric MRI of the bladder: inter-observer agreement and accuracy with the Vesical Imaging-Reporting and Data System (VI-RADS) at a single reference center

  • Giovanni Barchetti
  • Giuseppe Simone
  • Isabella Ceravolo
  • Vincenzo Salvo
  • Riccardo Campa
  • Francesco Del Giudice
  • Ettore De Berardinis
  • Dorelsa Buccilli
  • Carlo Catalano
  • Michele Gallucci
  • James W. F. Catto
  • Valeria PanebiancoEmail author



To evaluate accuracy and inter-observer variability using Vesical Imaging-Reporting and Data System (VI-RADS) for discrimination between non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC).


Between September 2017 and July 2018, 78 patients referred for suspected bladder cancer underwent multiparametric MRI of the bladder (mpMRI) prior to transurethral resection of bladder tumor (TURBT). All mpMRI were reviewed by two radiologists, who scored each lesion according to VI-RADS. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each VI-RADS cutoff. Receiver operating characteristics curves were used to evaluate the performance of mpMRI. The Ƙ statistics was used to estimate inter-reader agreement.


Seventy-five patients were included in the final analysis, 53 with NMIBC and 22 with MIBC. Sensitivity and specificity were 91% and 89% for reader 1 and 82% and 85% for reader 2 respectively when the cutoff VI-RADS > 2 was used to define MIBC. At the same cutoff, PPV and NPV were 77% and 96% for reader 1 and 69% and 92% for reader 2. When the cutoff VI-RADS > 3 was used, sensitivity and specificity were 82% and 94% for reader 1 and 77% and 89% for reader 2. Corresponding PPV and NPV were 86% and 93% for reader 1 and 74% and 91% for reader 2. Area under curve was 0.926 and 0.873 for reader 1 and 2 respectively. Inter-reader agreement was good for the overall score (Ƙ = 0.731).


VI-RADS is accurate in differentiating MIBC from NMIBC. Inter-reader agreement is overall good.

Key Points

• Traditionally, the local staging of bladder cancer relies on transurethral resection of bladder tumor.

• However, transurethral resection of bladder tumor carries a significant risk of understaging a cancer; therefore, more accurate, faster, and non-invasive staging techniques are needed to improve outcomes.

• Multiparametric MRI has proved to be the best imaging modality for local staging; therefore, its use in suitable patients has the potential to expedite radical treatment when necessary and non-invasive diagnosis in patients with poor fitness.


Urinary bladder neoplasms Magnetic resonance imaging Neoplasm grading Diffusion magnetic resonance imaging Neoplasm staging 



Apparent diffusion coefficient


Area under curve


Bladder cancer


Dynamic contrast-enhanced MRI


Diffusion-weighted imaging


Muscle-invasive bladder cancer


Multiparametric MRI of the prostate


Non-muscle-invasive bladder cancer


Receiver operating characteristics


Transurethral resection of bladder tumor


Vesical Imaging-Reporting and Data System



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Valeria Panebianco.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6117_MOESM1_ESM.docx (3.7 mb)
ESM 1 (DOCX 3750 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Giovanni Barchetti
    • 1
  • Giuseppe Simone
    • 2
  • Isabella Ceravolo
    • 1
  • Vincenzo Salvo
    • 1
  • Riccardo Campa
    • 1
  • Francesco Del Giudice
    • 3
  • Ettore De Berardinis
    • 3
  • Dorelsa Buccilli
    • 1
  • Carlo Catalano
    • 1
  • Michele Gallucci
    • 2
  • James W. F. Catto
    • 4
  • Valeria Panebianco
    • 1
    Email author
  1. 1.Department of Radiological Sciences, Oncology and PathologySapienza University of RomeRomeItaly
  2. 2.Department of UrologyRegina Elena National Cancer InsituteRomeItaly
  3. 3.Department of Gynecological-Obstetric and Urological SciencesSapienza University of RomeRomeItaly
  4. 4.Academic Urology UnitUniversity of SheffieldSheffieldUK

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