Role of Additional MRI‐Based Morphologic Measurements on the Performance of VI‐RADS for Muscle‐Invasive Bladder Cancer

Background Vesical Imaging‐Reporting and Data System (VI‐RADS) is a pathway for the standardized imaging and reporting of bladder cancer staging using multiparametric (mp) MRI. Purpose To investigate additional role of morphological (MOR) measurements to VI‐RADS for the detection of muscle‐invasive bladder cancer (MIBC) with mpMRI. Study Type Retrospective. Population A total of 198 patients (72 MIBC and 126 NMIBC) underwent bladder mpMRI was included. Field Strength/Sequence 3.0 T/T2‐weighted imaging with fast‐spin‐echo sequence, spin‐echo‐planar diffusion‐weighted imaging and dynamic contrast‐enhanced imaging with fast 3D gradient‐echo sequence. Assessment VI‐RADS score and MOR measurement including tumor location, number, stalk, cauliflower‐like surface, type of tumor growth, tumor‐muscle contact margin (TCM), tumor‐longitudinal length (TLL), and tumor cellularity index (TCI) were analyzed by three uroradiologists (3‐year, 8‐year, and 15‐year experience of bladder MRI, respectively) who were blinded to histopathology. Statistical Tests Significant MOR measurements associated with MIBC were tested by univariable and multivariable logistic regression (LR) analysis with odds ratio (OR). Area under receiver operating characteristic curve (AUC) with DeLong's test and decision curve analysis (DCA) were used to compared the performance of unadjusted vs. adjusted VI‐RADS. A P ‐value <0.05 was considered statistically significant. Results TCM (OR 9.98; 95% confidence interval [CI] 4.77–20.8), TCI (OR 5.72; 95% CI 2.37–13.8), and TLL (OR 3.35; 95% CI 1.40–8.03) were independently associated with MIBC at multivariable LR analysis. VI‐RADS adjusted by three MORs achieved significantly higher AUC (reader 1 0.908 vs. 0.798; reader 2 0.906 vs. 0.855; reader 3 0.907 vs. 0.831) and better clinical benefits than unadjusted VI‐RADS at DCA. Specially in VI‐RADS‐defined equivocal lesions, MOR‐based adjustment resulted in 55.5% (25/45), 70.4% (38/54), and 46.4% (26/56) improvement in accuracy for discriminating MIBC in three readers, respectively. Data Conclusion MOR measurements improved the performance of VI‐RADS in detecting MIBC with mpMRI, especially for equivocal lesions. Level of Evidence 3 Technical Efficacy Stage 2