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Novel utility of Vesical Imaging-Reporting and Data System in multimodal treatment for muscle-invasive bladder cancer

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Abstract

Objectives

To examine the clinical significance of the Vesical Imaging-Reporting and Data System (VI-RADS) in predicting outcome of multimodal treatment (MMT) in muscle-invasive bladder cancer (MIBC) patients.

Methods

We reviewed 78 pathologically proven MIBC patients who underwent MMT including transurethral resection and chemoradiotherapy, followed by partial or radical cystectomy. Treatment response was assessed through histologic evaluation of cystectomy specimens. Two radiologists categorized the index lesions of pretherapeutic MRI according to the 5-point VI-RADS score. The associations of VI-RADS score with the therapeutic effect of MMT were analyzed. The diagnostic performance of VI-RADS scores with a cut-off VI-RADS scores  ≤ 2 or ≤ 3 for predicting pathologic complete response to MMT (MMT-CR) was evaluated.

Results

MMT-CR was achieved in 2 (100%) of VI-RADS score 1 (n = 2), 16 (84%) of score 2 (n = 19), 12 (86%) of score 3 (n = 14), 7 (64%) of score 4 (n = 11), and 14 (44%) of score 5 (n = 32). VI-RADS score was inversely associated with the incidence of MMT-CR (p = 0.00049). The cut-off VI-RADS score  ≤ 2 and  ≤ 3 could predict the favorable therapeutic outcome of MMT with high specificity (0.89 with 95% confidence interval [CI]: 0.71–0.98 and 0.82 with 95% CI: 0.62–0.94, respectively) and high positive predictive value (0.86 with 95% CI: 0.64–0.97 and 0.86 with 95% CI: 0.70–0.95, respectively).

Conclusion

VI-RADS score may serve as an imaging marker in MIBC patients for predicting the therapeutic outcome of MMT.

Clinical relevance statement

Muscle-invasive bladder cancer patients with a lower Vesical Imaging-Reporting and Data System score can be a good candidate for bladder-sparing treatment incorporating multimodal treatment.

Key Points

• Vesical Imaging-Reporting and Data System (VI-RADS) score was potentially valuable for classifying pathologic tumor response in patients with muscle-invasive bladder cancer.

• The likelihood of achieving complete response of multimodal treatment (MMT) decreased with increasing VI-RADS score.

• VI-RADS score could serve as an imaging marker that optimizes patient selection for MMT.

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Abbreviations

ADC:

Apparent diffusion coefficient

bp:

Biparametric

CIS:

Carcinoma in situ

CR:

Complete response

CRT:

Chemoradiotherapy

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

IQR:

Interquartile range

MIBC:

Muscle-invasive bladder cancer

MMT:

Multimodal treatment

mp:

Multiparametric

MRI:

Magnetic resonance imaging

NNV:

Negative predictive value

pCR:

Pathologic complete response

PPV:

Positive predictive value

T2WI:

T2-weighted imaging

TUR:

Transurethral resection

UC:

Urothelial carcinoma

VI-RADS:

Vesical Imaging-Reporting and Data System

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Funding

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

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113–8510, Japan

    Koichiro Kimura, Junichi Tsuchiya, Yoshio Kitazume & Ukihide Tateishi

  2. Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113–8510, Japan

    Soichiro Yoshida, Yuma Waseda, Hajime Tanaka, Minato Yokoyama & Yasuhisa Fujii

  3. Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113–8510, Japan

    Kazuma Toda & Ryoichi Yoshimura

  4. Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Ito Masaya & Fumitaka Koga

Authors
  1. Koichiro Kimura
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  2. Soichiro Yoshida
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  13. Yasuhisa Fujii
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Corresponding author

Correspondence to Soichiro Yoshida.

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The scientific guarantor of this publication is Yasuhisa Fujii.

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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

No complex statistical methods were necessary for this paper.

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The study design was approved by the appropriate ethics review board, and written informed consent was obtained from each participant.

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• diagnostic or prognostic study

• multicenter study

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Kimura, K., Yoshida, S., Tsuchiya, J. et al. Novel utility of Vesical Imaging-Reporting and Data System in multimodal treatment for muscle-invasive bladder cancer. Eur Radiol 33, 6245–6255 (2023). https://doi.org/10.1007/s00330-023-09627-8

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  • DOI: https://doi.org/10.1007/s00330-023-09627-8

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