Preliminary Exploration of the Application of Vesical Imaging‐Reporting and Data System (VI‐RADS) in Post‐treatment Patients With Bladder Cancer: A Prospective Single‐Center Study

Abstract

Background Vesical Imaging‐Reporting and Data System (VI‐RADS) has been shown to be effective in diagnosing muscle invasion of bladder cancer (BC) in primary patients. Purpose To evaluate the diagnostic efficacy of VI‐RADS in a BC target population which included post‐treatment patients, and to determine the repeatability. Study Type Prospective. Population Seventy‐three patients (42 with primary BC, 31 with post‐treatment BC). Field Strength/Sequence 3.0 T MRI with propeller fast spin‐echo T2WI, echo planer imaging diffusion‐weighted imaging (DWI), and dynamic contrast‐enhanced imaging (DCEI). Assessment VI‐RADS scores were independently assessed by five radiologists with different levels of experience. The diagnostic efficiency in each group (primary and post‐treatment) and of each radiologist was assessed. Statistical Tests Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and area under the curve (AUC) in receiver operating characteristic curve analysis were calculated to evaluate VI‐RADS diagnostic performance. Interobserver agreement was assessed using weighted Kappa statistics. A P value <0.05 was considered statistically significant. Results At the corresponding cut‐off, AUC values of three groups range from 0.936 to 0.947 and AUC values of five observers range from 0.901 to 0.963. There was no significant difference between the AUCs in the primary and post‐treatment groups (P = 0.870). The cut‐off of the whole group and the post‐treatment group was ≥4, and the cut‐off of the primary group was ≥3. The Kappa values of interobserver agreements range from 0.709 to 0.923. Conclusions After expanding the target population to include post‐treatment patients, VI‐RADS still has good diagnostic efficacy and repeatability. VI‐RADS could potentially be a preoperative staging tool for post‐treatment patients. Level of Evidence 1 Technical Efficacy Stage 2

Editorial for “Preliminary Exploration of the Application of Vesical Imaging‐Reporting and Data System (VI‐RADS) in Post‐Treatment Patients with Bladder Cancer: A Prospective Single‐Center Study”

“…The area under the curves (AUCs) for the whole study population, primary, and post-treatment groups were 0.945, 0.936, and 0.947, respectively, with noninferiority in the post-treatment group compared to the primary group. 7 The performance of VI-RADS criteria in post-therapy setting agreed with prior reports (AUC range, 0.873-0.960). 8,9 Excellent inter-reader agreement (kappa range, 0.709-0.923) also agreed with previous reports in treatment-naïve populations (kappa range, 0.731-0.92).…”

“…The authors found outstanding performance of the VI‐RADS criteria for the diagnosis of MIBC in both clinical settings. The area under the curves (AUCs) for the whole study population, primary, and post‐treatment groups were 0.945, 0.936, and 0.947, respectively, with noninferiority in the post‐treatment group compared to the primary group 7 . The performance of VI‐RADS criteria in post‐therapy setting agreed with prior reports (AUC range, 0.873–0.960) 8,9 .…”

“…In this issue of JMRI , the authors applied the VI‐RADS criteria in a mixed population of patients with BCa in a prospective study, including those with treatment‐naïve tumors (“primary group”) and those with prior treatment (“post‐treatment group”) 7 . The authors identified two highly relevant clinical questions.…”

“…There were five observers with different levels of experience, with previous training in the evaluation of BCa. All patients underwent surgery (either TURBT, partial cystectomy, or radical cystectomy) by the same surgeons to ensure consistency 7 . The composite surgical reference standard used reflects a real‐world experience, as the use of radical cystectomy alone as the reference standard can bias studies toward higher grade BCa and potentially overestimate the diagnostic performance of the VI‐RADS scoring system.…”

“…5,6 In this issue of JMRI, the authors applied the VI-RADS criteria in a mixed population of patients with BCa in a prospective study, including those with treatment-naïve tumors ("primary group") and those with prior treatment ("post-treatment group"). 7 The authors identified two highly relevant clinical questions. First, how well does VI-RADS perform in the clinical setting, including in patients who have already undergone therapy for BCa?…”