Diagnostic Accuracy of Multi-Parametric MRI with VI-RADS Scoring for Differentiating Muscle-Invasive and Non-Muscle-Invasive Bladder Cancer: A Prospective Study

Background: Accurate bladder cancer (BC) staging is crucial for appropriate treatment strategies. Recent advances in imaging technologies emphasize the potential of multiparametric magnetic resonance imaging (mpMRI). This study aimed to evaluate the diagnostic accuracy of mpMRI in distinguishing between muscle-invasive (MIBC) and non-MIBC (NMIBC) compared to conventional cystoscopy and histopathological examination. Also, if we can use mpMRI as a follow up modality for BC, which may allow extending the time between follow up cystoscopies. Methods: This prospective study included 30 BC patients. Eligible patients underwent history, physical examination, radiology, and laboratory tests. Excluded patients had various contraindications. Preoperative mpMRI was performed, then diagnostic cystoscopy and TURBT, with histopathological examination are done.Results: The study involved 30 patients (93.3% male) with a mean age of 64.1 years. mpMRI VI-RADS scoring demonstrated high diagnostic performance in diagnosing muscle invasion in newly diagnosed cases with BC, with an AUC of 91.3%, sensitivity of 100%, specificity of 82.6%. In diagnosing muscle invasion in cases presented for their routine follow up of BC, mpMRI VI-RADS scoring had an AUC of 95%, sensitivity of 100%, specificity of 90%.Conclusion: This study highlights mpMRI with VI-RADS scoring as a valuable diagnostic tool for differentiating MIBC from NMIBC, and also detecting the presence of bladder masses in known BC patients during their routine follow-up. The findings suggest that mpMRI could serve as a less invasive alternative to cystoscopy in case of bladder mass absence, improving patient care and reducing risks associated with invasive procedures.