Implementing VIRADS score for image-guided assessment of muscle invasiveness in bladder cancer pre-TURBT: An updated meta-analysis.

Background: Bladder urothelial carcinoma is the most prevalent malignancy of the urinary system worldwide. Accurate staging of bladder cancer, particularly distinguishing between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), is essential for determining appropriate treatment. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy, sensitivity, and specificity of the vesical imaging-reporting and data system (VI-RADS) scoring system using multiparametric MRI in differentiating NMIBC from MIBC. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive searches were performed in PubMed, Web of Science, Embase, and Cochrane databases up to December 2023. Studies that evaluated the diagnostic accuracy of the VI-RADS scoring system using multiparametric magnetic resonance imaging (MRI) to distinguish between NMIBC and MIBC were included. Data from eligible studies were extracted to calculate pooled sensitivity and specificity, and heterogeneity was assessed using meta-regression and subgroup analyses by using STATA V17.0. Results: A total of 31 studies, comprising 3,798 bladder cancer patients, were included in the meta-analysis. The pooled sensitivity and specificity for predicting MIBC using a VI-RADS cutoff score of ≥ 3 was 89%, with moderate heterogeneity observed across studies. Subgroup analysis revealed variations in diagnostic performance based on geographic location (North America, Europe, and Asia), MRI technical parameters, and study design. Studies utilizing 3.0 Tesla MRI scanners and those involving multiple radiologists demonstrated higher diagnostic accuracy. Conclusion: The VI-RADS system demonstrates high diagnostic accuracy in distinguishing between NMIBC and MIBC, with a cutoff score of ≥ 3 yielding optimal sensitivity and specificity. Its integration into clinical practice has the potential to reduce the need for invasive procedures, improve staging accuracy, and expedite treatment decisions. Future research should focus on standardizing MRI protocols and further validating these findings across diverse clinical settings to enhance the utility of VI-RADS in bladder cancer management.