A Quantitative Modification of
VI
‐
RADS
for Bladder Cancer at the Ureteral Orifice: A Reader Study on
MRI
Erjia Guo, Li Chen, Yongliang Li, Peilin Fan, Yi Xie, Xinrong Fan, Lin Ma, Xiaoyuan Li, Yushi Yang, Houfeng Huang, Lili Xu, Hao Sun, Gumuyang Zhang ABSTRACT
Background
While the current Vesical Imaging Reporting and Data System (VI‐RADS) provides a valuable tool for evaluating bladder cancer, it is not tailored to the ureteral orifices and primarily relies on subjective evaluation.
Purpose
To identify significant parameters from MRI for diagnosing muscle‐invasive bladder cancer (MIBC) at the ureteral orifice, and to evaluate their incremental value to VI‐RADS for readers of varying experience.
Study Type
Retrospective.
Population
Development cohort: 81 patients with ureteral orifice bladder tumors (mean age, 68 ± 9; 60 men). External validation cohort: 34 patients (mean age, 63 ± 5; 22 men).
Field Strength/Sequence
3.0 T; fast spin‐echo T2‐weighted imaging, single‐shot echo planar diffusion‐weighted imaging, 3D spoiled gradient echo T1‐weighted dynamic contrast‐enhanced imaging.
Assessment
Four radiologists of varying experience independently assigned VI‐RADS scores. Quantitative parameters (tumor length, tumor contact length [TCL], stalk width [SW], and K trans ) and qualitative parameters were assessed. Pathology was the reference standard.
Statistical Tests
Intraclass correlation coefficient, weighted κ analysis, independent samples t ‐test, Mann–Whitney U test, chi‐square test, receiver operating characteristic curve analysis, univariate and multivariate logistic regression, 1000 bootstrap resamples, DeLong's test, and McNemar's test with Bonferroni correction. Significance was defined as p < 0.05, with p < 0.008 for multiple comparisons.
Results
Multivariate analysis identified TCL (odds ratio [OR] = 1.12) and stalk width (OR = 1.74) as independent predictors. In both cohorts, the TCL + SW‐modified VI‐RADS significantly improved sensitivity over the original VI‐RADS for diagnosing MIBC at the ureteral orifice in two junior radiologists. The TCL + SW‐modified VI‐RADS did not significantly improve sensitivity compared with the TCL‐modified VI‐RADS in either cohort ( p = 0.25–0.50).
Data Conclusion
The integration of TCL and stalk width into the VI‐RADS improves diagnostic performance for MIBC at the ureteral orifice, particularly for less‐experienced radiologists. Nevertheless, external validation in larger, multicenter cohorts is required.
Evidence Level
3.
Technical Efficacy
Stage 2.