Kufukihara et al [58] compared the diagnostic accuracy of VI-RADS scoring with cystoscopy and found that VI- RADS had superior performance in detecting detrusor muscle invasion, especially in tumors located at the bladder neck/trigone/dome/posterior and anterior wall, but inferior performance in detecting tumors located on the lateral wall or ureteral orifice. Makboul et al [59] evaluated the usefulness of multiparametric MRI in differentiating MIBC from NMIBC with the accuracy of the VI-RADS scoring system. They found that multiparametric MRI is a comprehensive and effective tool for determining muscle invasion in bladder cancer and that VI-RADS can accurately differentiate between MIBC and NMIBC. Hagen et al [60] assessed the clinical applicability of preoperative multiparametric MRI using the 5-point VI-RADS scoring system to stage bladder cancer and compared it with dual-phase contrast-enhanced CT (CECT). Both CECT and multiparametric MRI correctly identified tumor stages as either MIBC or NMIBC, but T stages bordering the histopathologic limits of muscle invasiveness resulted in overestimation of muscle invasion in 43% of cases for the multiparametric MRI image data sets and underestimation of muscle invasion in up to 55.5% of cases for the CECT data. Pretreatment Staging of Urothelial Cancer MRI Pelvis Without IV Contrast There is little literature to support the use of MRI pelvis without IV contrast in the evaluation of NMIBC. The addition of gadolinium contrast agent on MRI has been found to improve the accuracy of local staging for bladder cancer. In a prospective study by Daneshmand et al [61], 122 patients were examined using contrast-enhanced MRI, which had an 88% sensitivity, a 48% specificity, and a 74% accuracy in distinguishing organ-confined from non- organ-confined bladder cancer and a 41% sensitivity, a 92% specificity, and an 80% accuracy in detecting positive nodal disease.
Pretreatment Staging of Urothelial Cancer. Kufukihara et al [58] compared the diagnostic accuracy of VI-RADS scoring with cystoscopy and found that VI- RADS had superior performance in detecting detrusor muscle invasion, especially in tumors located at the bladder neck/trigone/dome/posterior and anterior wall, but inferior performance in detecting tumors located on the lateral wall or ureteral orifice. Makboul et al [59] evaluated the usefulness of multiparametric MRI in differentiating MIBC from NMIBC with the accuracy of the VI-RADS scoring system. They found that multiparametric MRI is a comprehensive and effective tool for determining muscle invasion in bladder cancer and that VI-RADS can accurately differentiate between MIBC and NMIBC. Hagen et al [60] assessed the clinical applicability of preoperative multiparametric MRI using the 5-point VI-RADS scoring system to stage bladder cancer and compared it with dual-phase contrast-enhanced CT (CECT). Both CECT and multiparametric MRI correctly identified tumor stages as either MIBC or NMIBC, but T stages bordering the histopathologic limits of muscle invasiveness resulted in overestimation of muscle invasion in 43% of cases for the multiparametric MRI image data sets and underestimation of muscle invasion in up to 55.5% of cases for the CECT data. Pretreatment Staging of Urothelial Cancer MRI Pelvis Without IV Contrast There is little literature to support the use of MRI pelvis without IV contrast in the evaluation of NMIBC. The addition of gadolinium contrast agent on MRI has been found to improve the accuracy of local staging for bladder cancer. In a prospective study by Daneshmand et al [61], 122 patients were examined using contrast-enhanced MRI, which had an 88% sensitivity, a 48% specificity, and a 74% accuracy in distinguishing organ-confined from non- organ-confined bladder cancer and a 41% sensitivity, a 92% specificity, and an 80% accuracy in detecting positive nodal disease.