Submucosal Linear Enhancement in Adjusted VI-RADS: Enhancing Detection of Muscle-Invasive Bladder Cancer Using Isotropic DCE-MRI

Motivation: The Vesical Imaging Reporting and Data System (VI-RADS) is widely used to evaluate muscle invasion, but it has inherent limitations. Discontinuous submucosal linear enhancement (SLE) may suggest muscle-invasive bladder cancer (MIBC). Goal(s): The aim was to evaluate the value of incorporating SLE into the VI-RADS to improve muscle invasion prediction in bladder cancer. Approach: Three-dimensional isotropic DCEI data were reformatted into arbitrary planes across different phases to classify SLE as continuous, disrupted, or absent. An adjusted VI-RADS score was developed by integrating SLE status and VI-RADS. Results: The adjusted VI-RADS score significantly improved the performance for predicting MIBC compared to the standard VI-RADS. Impact: Incorporating submucosal linear enhancement (SLE) into the VI-RADS system significantly improves the detection of muscle-invasive bladder cancer. This adjustment could lead to earlier, more accurate staging and treatment planning, ultimately enhancing patient outcomes by reducing missed diagnoses of MIBC.