From the Departments of Radiology (H.W., J.G., S.L., Y.G.) and Urology (C.L., H.Y., J.C., J.L., L.C.), The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, PR China; and Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (F.Z.).
Radiology. 2019 Jun;291(3):668-674. doi: 10.1148/radiol.2019182506. Epub 2019 Apr 23.
Background The Vesical Imaging-Reporting and Data System (VI-RADS) scoring system was created in 2018 to standardize imaging and reporting of bladder cancer staging with multiparametric MRI. The system provides a five-point VI-RADS score, which suggests the likelihood of detrusor muscle invasion. Muscle-invasive disease carries a worse prognosis and requires radical surgery. Purpose To determine the performance of the VI-RADS score in detecting muscle-invasive bladder cancer in a cohort of patients undergoing multiparametric MRI before surgery. Materials and Methods In this retrospective study, a total of 340 patients with bladder cancer were identified from a database of consecutive patients undergoing multiparametric MRI from November 2011 to August 2018. The tumor with the largest burden was selected in those patients with multifocal tumors. Bladder tumors were retrospectively categorized according to the VI-RADS five-point scoring system by two readers, independently and in consensus, who were blinded to histologic findings. The VI-RADS score was compared with postoperative pathology for each tumor, and the performance of VI-RADS for determining detrusor muscle invasion was analyzed by using the Cochran-Armitage test. Results Among the 340 patients, there were 296 men and 44 women; the median age was 64.0 years (interquartile range [IQR], 57.0-87.0 years). Of 340 tumors, 255 (75.0%) were verified as non-muscle-invasive and 85 (25.0%) as muscle-invasive bladder cancer. Both the VI-RADS score and its components were associated with muscle-invasive condition ( < .001). The area under the receiver operating characteristic curve for VI-RADS for muscle invasion was 0.94 (95% confidence interval [CI]: 0.90, 0.98). The sensitivity and specificity of a VI-RADS score of 3 or greater were 87.1% (95% CI: 78%, 93%) and 96.5% (95% CI: 93%, 98%), respectively. Conclusion The Vesical Imaging-Reporting and Data System score effectively defines the likelihood of detrusor muscle invasion in bladder cancer and should be considered for evaluation of tumors prior to surgery. © RSNA, 2019 See also the editorial by Margolis and Hu in this issue.
背景：膀胱成像报告和数据系统（VI-RADS）评分系统于 2018 年创建，旨在对多参数 MRI 检查的膀胱癌分期进行成像和报告标准化。该系统提供了一个 5 分的 VI-RADS 评分，提示逼尿肌侵犯的可能性。侵袭性疾病预后较差，需要根治性手术。目的：在一组接受多参数 MRI 术前检查的患者中，确定 VI-RADS 评分在检测肌层浸润性膀胱癌中的性能。材料与方法：在这项回顾性研究中，从 2011 年 11 月至 2018 年 8 月连续接受多参数 MRI 检查的患者数据库中确定了 340 例膀胱癌患者。在有多病灶肿瘤的患者中，选择肿瘤负荷最大的肿瘤。由两位读者独立地并通过盲法根据 VI-RADS 五分制评分系统对膀胱肿瘤进行回顾性分类，评分系统的五分制评分分别为 1 分、2 分、3 分、4 分和 5 分。1 分代表未见异常，2 分代表良性，3 分代表可能良性，4 分代表可疑恶性，5 分代表高度怀疑恶性。两位读者独立评估后进行共识评估。将 VI-RADS 评分与术后病理进行比较，采用 Cochran-Armitage 检验分析 VI-RADS 对确定逼尿肌侵犯的性能。结果：在 340 例患者中，男 296 例，女 44 例；中位年龄为 64.0 岁（四分位距[IQR]，57.0-87.0 岁）。340 个肿瘤中，255 个（75.0%）为非肌层浸润性膀胱癌，85 个（25.0%）为肌层浸润性膀胱癌。VI-RADS 评分及其各组成部分均与肌层浸润情况相关（ <.001）。用于肌层侵犯的 VI-RADS 曲线下面积为 0.94（95%置信区间[CI]：0.90，0.98）。VI-RADS 评分≥3 分的敏感性和特异性分别为 87.1%（95%CI：78%，93%）和 96.5%（95%CI：93%，98%）。结论：膀胱成像报告和数据系统评分能有效确定膀胱癌逼尿肌侵犯的可能性，应在术前评估肿瘤时考虑使用。 © 2019 RSNA. 本期杂志还包含 Margolis 和 Hu 的社论。
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