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VI-RADS Score Performance in the Post-TURBT Setting: Exploring the Need for Modification
Ailin Dehghanpour1, Martina Pecoraro2, Gu-Mu-Yang Zhang3
1Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy; Department of Experimental Medicine, Sapienza University of Rome, Italy.
Background:
The Vesical Imaging-Reporting and Data System (VI-RADS) was introduced to standardize bladder magnetic resonance imaging (MRI) interpretation, mainly in treatment-naïve patients. However, most patients undergo MRI after transurethral resection of bladder tumor (TURBT), where postprocedural changes compromise diagnostic accuracy. This study aimed to identify the dominant sequence for post-TURBT VI-RADS scoring, define optimal MRI timing, and evaluate the effect of image quality.
Methods:
This retrospective single-center study included patients with bladder cancer who underwent TURBT followed by MRI. Three radiologists assigned standard, diffusion-weighted imaging (DWI)-dominant, and dynamic contrast-enhanced (DCE)-dominant VI-RADS scores using a cutoff of ≥3. Histopathology from re-TURBT or cystectomy served as the reference standard. Diagnostic performance was assessed with receiver operating characteristic analysis and stratified by time interval (<2 wk, 2-4 wk, >4 wk) and VI-RADS Quality Score (QS). Inter-reader agreement was evaluated using pairwise Cohen's κ and overall Fleiss' κ.
Results:
The final cohort comprised 123 patients. Standard and DCE-dominant VI-RADS produced identical results (area under the curve [AUC] = 0.81; sensitivity = 95%; specificity = 67%; accuracy = 77%). For DWI-dominant VI-RADS, AUC ranged from 0.86 to 0.95 and accuracy from 86% to 96% across readers. Inter-reader agreement was excellent (overall Fleiss' κ = 0.91-0.96; pairwise Cohen's κ = up to 0.98). Diagnostic accuracy varied by time interval, reaching its lowest within 2 wk (specificity = 13%, accuracy = 26%) and improving at 2-4 wk (accuracy = 94-98%). Accuracy also improved with increasing QS. The study is limited by its retrospective design and single-center setting.
Conclusion:
Bladder MRI after TURBT remains accurate when timing, sequence weighting, and image quality are considered. DWI-dominant VI-RADS shows numerically higher diagnostic estimates. Scheduling MRI ≥2-4 wk after TURBT and ensuring adequate image quality may improve reliability.
