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Clinical utility of the Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer between radiologists and urologists based on multiparametric MRI including 3D FSE T2-weighted acquisitions

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Abstract

Objectives

To investigate the clinical utility of the Vesical Imaging-Reporting and Data System (VI-RADS) by comparing its diagnostic performance for muscle-invasive bladder cancer (MIBC) between radiologists and urologists based on multiparametric MRI, including three-dimensional (3D) fast spin-echo (FSE) T2-weighted acquisitions.

Methods

This study included 66 treatment-naïve patients (60 men, 6 women; mean age 74.0 years) with pathologically proven bladder cancer who underwent multiparametric MRI, including 3D FSE T2-weighted imaging, before transurethral bladder tumour resection between January 2010 and November 2018. The MRI scans were categorised according to the five-point VI-RADS score by four independent readers (two board-certified radiologists and board-certified urologists each), blinded to the histopathological findings. The VI-RADS scores were compared with the postoperative histopathological diagnosis. Interobserver agreement was assessed using weighted kappa coefficients. ROC analysis and generalised estimating equations were used to evaluate the diagnostic performance.

Results

Forty-nine (74.2%) and 17 (25.8%) tumours were confirmed to be non-MIBC and MIBC, respectively, based on pathological examination. The interobserver agreement was good-to-excellent between all pairs of readers (range, 0.73–0.91). The urologists’ sensitivity/specificity values for DCE-MRI VI-RADS scores were significantly lower than those of radiologists. No significant differences were observed for the overall VI-RADS score. The AUC for the overall VI-RADS score was 0.94, 0.92, 0.89, and 0.87 for radiologists 1 and 2 and urologists 1 and 2, respectively.

Conclusions

The VI-RADS score, based on multiparametric MRI including 3D FSE T2-weighted acquisitions, can be useful for radiologists and urologists to determine the bladder cancer muscle invasion status preoperatively.

Key Points

• VI-RADS (using multiparametric MRI including 3D FSE T2-weighted acquisitions) achieves good to excellent interobserver agreement and has similar diagnostic performance for detecting muscle invasion by both radiologists and urologists.

• The diagnostic performance of the overall VI-RADS score is high for both radiologists and urologists, particularly due to the dominant effect of diffusion-weighted imaging on the overall VI-RADS score.

• The sensitivity and specificity values of the T2WI VI-RADS scores for four readers in our study (using 3D FSE T2-weighted acquisitions) were similar (with slightly higher specificity values) to previously published results (using 2D FSE T2-weighted acquisitions).

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Abbreviations

BCa:

Bladder cancer

EAU:

European Association of Urology

FSE:

Fast spin echo

MIBC:

Muscle-invasive bladder cancer

Mp-MRI:

Multiparametric MRI

NMIBC:

Non-muscle-invasive bladder cancer

SI:

Signal intensity

T2WI:

T2-weighted imaging

TURBT:

Transurethral resection of bladder tumour

VI-RADS:

Vesical Imaging-Reporting and Data System

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Acknowledgments

The authors thank Dr. Kei Miyahira, Dr. Yuki Iwaita, Mr. Yoshinobu Nunokawa, Ms. Sari Motomatsu, and Mr. Hayato Ogawa for their help with data collection.

Funding

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

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Authors and Affiliations

  1. Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yuki Arita, Hirotaka Akita, Tatsuya Suzuki, Shigeo Okuda & Masahiro Jinzaki

  2. Department of Urology, Keio University School of Medicine, Tokyo, Japan

    Keisuke Shigeta, Ryohei Kufukihara & Mototsugu Oya

  3. Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Thomas C. Kwee

  4. Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan

    Ryota Ishii

  5. Department of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan

    Shuji Mikami

  6. Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan

    Eiji Kikuchi

Authors
  1. Yuki Arita
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Corresponding author

Correspondence to Masahiro Jinzaki.

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Guarantor

The scientific guarantor of this publication is Dr. Masahiro Jinzaki.

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

Mr. Ryota Ishii, who is one of the authors, has significant statistical expertise.

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Written informed consent was waved by the Institutional Review Board due to the retrospective nature of this study.

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Institutional Review Board approval was obtained.

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• retrospective

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• performed at one institution

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Arita, Y., Shigeta, K., Akita, H. et al. Clinical utility of the Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer between radiologists and urologists based on multiparametric MRI including 3D FSE T2-weighted acquisitions. Eur Radiol 31, 875–883 (2021). https://doi.org/10.1007/s00330-020-07153-5

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