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.
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.
Retrospective.
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).
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.
Four radiologists of varying experience independently assigned VI-RADS scores. Quantitative parameters (tumor length, tumor contact length [TCL], stalk width [SW], and Ktrans) and qualitative parameters were assessed. Pathology was the reference standard.
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.
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).
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.
3.
Stage 2.
This study aimed to identify significant parameters from MRI for diagnosing muscle‐invasive bladder cancer (MIBC) at the ureteral orifice, and to evaluate their incremental value to the original VI‐RADS among readers with differing experience levels. Tumor contact length (TCL) and stalk width (SW) were found to be independent predictors of muscle invasion. Integrating TCL and SW into VI‐RADS improved diagnostic sensitivity for MIBC at the ureteral orifice, particularly for less‐experienced readers. The TCL + SW‐modified VI‐RADS offers a practical tool to assess bladder cancers at the ureteral orifice, particularly aiding less‐experienced radiologists in achieving more reliable preoperative assessment of this challenging subsite.
Journal of magnetic resonance imaging : JMRI. 2026 Jul 02 [Epub ahead of print]
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
Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China., Department of Radiology, The Fourth People's Hospital of Jinan, Jinan, Shandong Province, China., Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China., Department of Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China., Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China., Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.