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Biparametric magnetic resonance imaging assessment for detection of muscle-invasive bladder cancer: a systematic review and meta-analysis

  • Magnetic Resonance
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Abstract

Objectives

To investigate if removing DCE from the Vesical Imaging Reporting and Data System (VI-RADS) influences the diagnostic accuracy of muscle-invasive bladder cancer (MIBC). We also explored using different reference standards on the MRI diagnostic performance.

Methods

We searched the Cochrane Library, Embase, and PubMed databases to June 26, 2021. Pooled biparametric MRI (bpMRI, T2WI+DWI) and multiparametric MRI (mpMRI, T2WI+DWI+DCE) sensitivities and specificities and the diagnostic performances of these methods for MIBC were compared using different reference standards.

Results

Seventeen studies with 2344 patients were finally included, of which 7 studies, including 1041 patients, reported the diagnostic performance of bpMRI. VI-RADS showed sensitivities and specificities of 0.91 (95% CI 0.87–0.94) and 0.86 (95% CI 0.77–0.91) at cutoff scores of 3, and 0.85 (95% CI 0.77–0.90) and 0.93 (95% CI 0.89–0.96) at cutoff scores of 4. BpMRI showed sensitivities and specificities of 0.90 (95% CI 0.69–0.97) and 0.90 (95% CI 0.81–0.95), and 0.84 (95% CI 0.78–0.88) and 0.97 (95% CI 0.87–0.99), respectively, for cutoff scores of 3 and 4. The sensitivities of bpMRI vs mpMRI for MIBC were not significantly different, but bpMRI was more specific than mpMRI at cutoff scores of 3 (p = 0.02) and 4 (p = 0.02). The VI-RADS studies using primary transurethral resection of bladder tumors (TURBT) as the reference standard had significantly higher sensitivities (p < 0.001) than those using secondary TURBT or radical cystectomy as the reference.

Data conclusion

BpMRI and conventional VI-RADS had similar diagnostic efficacies for MIBC. Since MRI overestimated MIBC diagnoses using primary TURBT as the reference standard, we recommend using secondary TURBT as the reference standard.

Key Points

• Biparametric MRI without DCE had similar diagnostic efficacies for MIBC compared with conventional VI-RADS.

• The sensitivity of VI-RADS was overestimated when referring to the primary TURBT results.

• Biparametric MRI comprised of T2WI and DWI could be used for detecting MIBC in clinical practice.

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Abbreviations

AUC:

Area under the curve

BC:

Bladder cancer

BpMRI:

Biparametric magnetic resonance imaging

DCE:

Dynamic contrast enhancement

DWI:

Diffusion-weighted imaging

HsROC:

Hierarchical summary receiver operating characteristic curve

MIBC:

Muscle-invasive bladder cancer

mpMRI:

Multiparametric magnetic resonance imaging

NMIBC:

Non-muscle-invasive bladder cancer

NPV:

Negative predictive value

PPV:

Positive predictive value

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

RC:

Radical cystectomy

T2WI:

T2-weighted imaging

TURBT:

Transurethral resection of bladder tumor

VI-RADS:

Vesical Imaging Reporting and Data System

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Funding

National Science Foundation of China Youth Fund (No. 31801066)

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Author notes

  1. Lei Ye and Yuntian Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China

    Lei Ye, Yuntian Chen, Hui Xu, Huimin Xie, Jin Yao & Bin Song

  2. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, China

    Jiaming Liu

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  1. Lei Ye
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Correspondence to Jin Yao or Jiaming Liu.

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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.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was not required for this study because this study was a meta-analysis.

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This study was conducted at West China Hospital, Sichuan University, Chengdu, China.

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Ye, L., Chen, Y., Xu, H. et al. Biparametric magnetic resonance imaging assessment for detection of muscle-invasive bladder cancer: a systematic review and meta-analysis. Eur Radiol 32, 6480–6492 (2022). https://doi.org/10.1007/s00330-022-08696-5

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