Akademik Veri Yönetim Sistemi
European Congress of Radiology, Vienna, Avusturya, 1 - 05 Mart 2023, cilt.1, sa.1, ss.1, (Tam Metin Bildiri)
Background:
Bladder cancer is the 10th most common cancer type all over the World. (1)
In 2022 an estimated 81,180 adults (men are at higher risk four times) will be diagnosed with bladder cancer. The classic presentation of urothelial carcinoma gross hematuria in elderly men. (2)
Nevertheless, in current treatments, mortality rates depend on early diagnoses. The most critical prognostic factor in determining the presence of muscle invasion. Urothelial tumors are classified as either invading muscle (nonpapillary) or not invading muscle (superficial or papillary ) (1) (Table -1).
The luminal protrusion may be revealed by cystoscopy, but muscular layer invasion or extension to adjacent organs may be detected by MRI. VI-RADS is a structured reporting system for suspected bladder cancer. It was proposed in 2018(3).
The assessment of bladder lesions is based on multiparametric MRI (mpMRI) findings. High-resolution T2-weighted imaging (T2WI) sequences, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) provide critical information for the evaluation of bladder lesions. (1)(Figure.1)
Although non-muscle invasive bladder cancers (NMIBC) can be managed with transurethral resection of bladder tumor (TURBT) (3). Radical cystectomy is the common treatment choice for muscle-invasive bladder cancer (MIBC). VI-RADS aims to discriminate between NMIBC from MIBC, also VI-RADS score as a predictor of re-excision risk in patients with high-risk NMIBC (1).
Findings and procedure details:
The staging of bladder lesions is based on the assessment of muscle invasion. The detrusor muscle appears as a low signal intensity line on T2WI along the bladder wall with intermediate signal intensity on DWI, but no early enhancement on DCE(1). The presence of an interruption in this hypointense line is significant for muscle invasion. (Figure.2) DWI can identify regions of diffusion restriction, which characteristically is seen in urothelial carcinoma; this tumor appears hyperintense on DWI with corresponding hypointensity on the apparent diffusion coefficient (ADC) map.
Each malignant lesion is assigned a score from 1 to 5 in three categories: structural category (SC) on T2WI(Table.2), DCE (Table.3), and DWI (Table.4). The score corresponds to highly unlikely [1], unlikely [2], equivocal [3], likely [ 4], and very likely [5] Detrusor muscle invasion. (Figure 3-8 )
Using mpMRI with a novel standardized reporting system has many potential clinical applications. The high diagnostic accuracy makes it a candidate for staging individuals with urothelial carcinoma and identifying high-risk individuals who may need re-TURBT or proceed to radical cystectomy
Conclusion:
VI-RADS helps radiologists become aware of what to consider when staging. This system also helps departments introduce structured reporting
References:
1-Brian S. Wong, Cihan Duran, Stephen B. William; Vesical imaging reporting and data system (VI-RADS) and impact on identifying the depth of invasion with subsequent management in bladder cancer patients; .doi.org/10.21037/tau-20-839
2-Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
3-Barchetti G, Simone G, Ceravolo I, et al. Multiparametric MRI of the bladder: inter-observer agreement and accuracy with the Vesical Imaging-Reporting and Data System (VI-RADS) at a single reference center. Eur Radiol 2019;29:5498-506.