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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

Abstract

Objectives

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).

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under curve

BCa:

Bladder cancer

DCE-MRI:

Dynamic contrast-enhanced MRI

DWI:

Diffusion-weighted imaging

MIBC:

Muscle-invasive bladder cancer

mpMRI:

Multiparametric MRI of the prostate

NMIBC:

Non-muscle-invasive bladder cancer

ROC:

Receiver operating characteristics

TURBT:

Transurethral resection of bladder tumor

VI-RADS:

Vesical Imaging-Reporting and Data System

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Correspondence to Valeria Panebianco.

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The scientific guarantor of this publication is Valeria Panebianco.

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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.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Barchetti, G., Simone, G., Ceravolo, I. et al. 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. Eur Radiol 29, 5498–5506 (2019). https://doi.org/10.1007/s00330-019-06117-8

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  • DOI: https://doi.org/10.1007/s00330-019-06117-8

Keywords

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