Practical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and Pitfalls
Jônatas Fávero Prietto Dos Santos1, Caroline Lorenzoni Almeida Ghezzi1, Ivan Morzoletto Pedrollo1
1From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.).
Accurately staging bladder cancer (BC) is crucial for treatment. Multiparametric MRI with the Vesical Imaging Reporting and Data System (VI-RADS) offers improved accuracy over transurethral resection of bladder tumor (TURBT) for detecting muscle invasion.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Urothelial carcinoma is the most common bladder cancer (BC), necessitating accurate tumor staging for treatment and prognosis.
- Differentiating non-muscle-invasive BC from muscle-invasive BC (MIBC) is vital, as MIBC often requires neoadjuvant therapy followed by radical cystectomy.
- Transurethral resection of bladder tumor (TURBT) is the standard for staging but frequently leads to understaging due to inadequate sampling of the muscularis propria.
Purpose of the Study:
- To evaluate the utility of multiparametric MRI in assessing bladder cancer tumor staging.
- To highlight the role of the Vesical Imaging Reporting and Data System (VI-RADS) in standardizing bladder MRI interpretation for muscle invasion.
- To compare the diagnostic performance of MRI-based staging with traditional TURBT methods.
Main Methods:
- Utilized multiparametric MRI, including T2-weighted, diffusion-weighted (DW), and dynamic contrast-enhanced (DCE) sequences.
- Applied the 5-point VI-RADS classification system to assess the likelihood of detrusor muscle invasion.
- Focused on specific imaging features such as stalk presence, inner layer thickening, and signal intensity interruption in the muscular layer.
Main Results:
- Multiparametric MRI, particularly diffusion-weighted imaging, can overcome limitations of TURBT in bladder cancer staging.
- VI-RADS provides a standardized approach to interpreting bladder MRI for muscle invasion.
- Specific imaging findings on MRI can predict the likelihood of muscle invasion, aiding in differentiating MIBC from non-MIBC.
Conclusions:
- Multiparametric MRI with VI-RADS is a valuable tool for accurate bladder cancer staging, especially in differentiating MIBC.
- This imaging modality can potentially reduce the risks of residual disease, recurrence, and understaging associated with TURBT.
- Standardized MRI interpretation through VI-RADS improves diagnostic confidence and clinical decision-making for bladder cancer patients.
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