ArticleEuropean radiology2026
Multiparametric MRI for assessing residual tumors in patients with muscle-invasive bladder cancer after neoadjuvant treatment: a reliable tool for guiding bladder preservation.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the clinical utility of multiparametric MRI in differentiating pathological stages (ypT0 vs ypT1-4) in patients with muscle-invasive bladder cancer (MIBCa) following neoadjuvant therapy (NAT). MATERIALS AND
methodsIn this double-center cohort study, post-NAT multiparametric MRI in all consecutive patients who underwent surgery after NAT was analyzed. Two experienced radiologists independently evaluated the MRI features obtained after NAT. The post-NAT yT stage was assigned based on T2-weighted diffusion-weighted imaging (T2DWI) and on contrast-enhanced MRI scans. The diagnostic accuracies for distinguishing post-NAT ypT0 from ypT1-4 tumors with the two protocols were evaluated. Cohen's kappa (κ) statistics were used to evaluate the consistency between readers for the post-NAT yT stage.
resultsA total of 149 patients (mean age, 62 years ± 10 [SD]; 131 men) from two institutions were enrolled. The area under the receiver operating characteristic curve of the contrast-enhanced MRI protocol in predicting post-NAT ypT0 stage was 0.84 (95% CI: 0.77, 0.91), which was better than that of the T2DWI protocol (0.75; 95% CI: 0.67, 0.81; p = 0.002). The interobserver agreement was excellent for both the T2DWI protocol (κ = 0.89) and the contrast-enhanced MRI protocol (κ = 0.85).
conclusionsMultiparametric MRI, particularly contrast-enhanced MRI, demonstrated superior accuracy in identifying ypT0 status following NAT in MIBCa, establishing it as an essential diagnostic tool for guiding bladder preservation in clinical decision-making. KEY POINTS: Question Accurately identifying pathological complete response (ypT0) after NAT is essential for selecting bladder-preservation strategies, yet remains clinically challenging. Findings Post-treatment contrast-enhanced MRI accurately identified ypT0 status with an AUC of 0.84 and excellent inter-reader agreement, outperforming T2DWI. Clinical relevance Contrast-enhanced MRI is a reliable, non-invasive method for detecting complete tumor response after NAT, enabling better patient selection for bladder-sparing approaches and potentially improving quality of life.
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