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The validity, reliability, and reviewer acceptance of VI-RADS in assessing muscle invasion by bladder cancer: a multicenter prospective study

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Abstract

Objective

To assess diagnostic validity and reliability of VI-RADS in predicting muscle invasion by bladder cancer (BCa) and evaluate reviewer acceptance of VI-RADS for clinical routine.

Methods

A prospective multicenter study enrolled 331 patients with suspected/untreated BCa who underwent preoperative multiparametric MRI examination (mp-MRI) of the urinary bladder. Four experienced radiologists independently evaluated all mp-MRI using VI-RADS. The diagnostic validity of VI-RADS for predicting muscle invasion by BCa was calculated using histopathology of the first transurethral resection bladder tumor (TURBT) and second TURBT as the reference standards. The kappa statistics (κ) were applied to assess the interreader agreement (IRA). Reviewer acceptance was evaluated with questionnaires.

Results

The risk of muscle invasion in VI-RADS 2, 3, 4, and 5 after the first and second TURBT was 21.8%, 45.8%, 69.6%, and 96.4% and 24.4%, 58.3%, 87%, and 99.2%, respectively. The overall diagnostic validity of VI-RADS was high. The optimal cut-off value for predicting muscle invasion after first TURBT was > VI-RADS 3 (sensitivity = 84.1% and specificity = 92.3%), and after second TURBT was > VI-RADS 2 (sensitivity = 89.9% and specificity = 90.1%). VI-RADS categorization showed a very good IRA (κ = 0.93). Reviewers fully agreed with the statement, “The application of structured reporting of bladder tumor should be encouraged” (score = 20).

Conclusions

VI-RADS showed high diagnostic validity and reliability for predicting muscle invasion by BCa, especially VI-RADS 4 and 5. However, VI-RADS 2 and 3 require further modifications to enhance their diagnostic validity. VI-RADS is highly encouraged to be used in daily practice.

Key Points

• VI-RADS showed high diagnostic validity and reliability in predicting BCa muscle invasion, especially VI-RADS 4 and 5.

• In VI-RADS 2 and 3, we observed a notable percentage of BCa with muscle invasion and this would require further modifications to enhance the diagnostic validity for these scores.

• Overall VI-RADS is well-accepted by radiologists who recommend it for daily practice.

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Abbreviations

BCa:

Bladder cancer

DCE-MRI:

Dynamic contrast-enhanced imaging

DWI:

Diffusion-weighted imaging

MIBC :

Muscle-invasive bladder cancer

mp-MRI:

Multiparametric magnetic resonance imaging

NMIBC:

Non-muscle-invasive bladder cancer

SI:

Signal intensity

T2WI:

T2-weighted imaging

TURBT:

Transurethral resection of the bladder tumor

VI-RADS:

Vesical imaging-reporting and data system

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Acknowledgements

The authors thank all staff members and colleagues in the Radiology and Urology Departments at Zagazig University for their helpful cooperation.

Funding

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

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Authors and Affiliations

  1. Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Maha Ibrahim Metwally, Nesma Adel Zeed, Enas Mahmoud Hamed, Al Shaimaa Fathi Elshetry, Rabab Mahmoud Elfwakhry, Ahmed M. Alaa Eldin & Mohammad Abd Alkhalik Basha

  2. Department of Urology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Ahmed Sakr

  3. Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt

    Sameh Abdelaziz Aly

  4. Department of Radio-diagnosis, Faculty of Human Medicine, Suez Canal University, Ismailia, Egypt

    Walid Mosallam

  5. Department of Radio-diagnosis, Al-Ahrar Teaching Hospital, Zagazig, Egypt

    Yara Mohammed Ahmad Ziada

  6. Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Rawda Balata

  7. Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Ola A. Harb

Authors
  1. Maha Ibrahim Metwally
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  2. Nesma Adel Zeed
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  3. Enas Mahmoud Hamed
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  4. Al Shaimaa Fathi Elshetry
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  7. Ahmed Sakr
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  8. Sameh Abdelaziz Aly
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  10. Yara Mohammed Ahmad Ziada
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  11. Rawda Balata
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  12. Ola A. Harb
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  13. Mohammad Abd Alkhalik Basha
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Corresponding author

Correspondence to Mohammad Abd Alkhalik Basha.

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Guarantor

The scientific guarantor of this publication is Mohammad Abd Alkhalik Basha.

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 obtained by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Multicenter study

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Supplementary information

Table E1

Clinical-pathologic Characteristics of Patients and Bladder Tumors. Table E2. Frequency Distributions of VI-RADS Classification System for 331 Bladder Tumors Stratified by Readers (DOCX 22 kb)

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Metwally, M.I., Zeed, N.A., Hamed, E.M. et al. The validity, reliability, and reviewer acceptance of VI-RADS in assessing muscle invasion by bladder cancer: a multicenter prospective study. Eur Radiol 31, 6949–6961 (2021). https://doi.org/10.1007/s00330-021-07765-5

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  • DOI: https://doi.org/10.1007/s00330-021-07765-5

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