VI-RADS quality score: development and proposal of a scoring system by the American College of Radiology VI-RADS Steering Committee.

High-quality bladder MRI is essential for reliable detection and characterization of bladder tumors. While the Vesical Imaging Reporting and Data System (VI-RADS) was developed to standardize acquisition, interpretation, and reporting of MRI for bladder cancer staging, no universal scoring system has been established for quality assessment. A systematic review showed that existing efforts for bladder MRI quality assessment have largely relied on study-specific, subjective Likert-type scales, with substantial variability, hindering reproducibility and comparability across studies and institutions. In this paper, we describe a novel bladder MRI scoring system that was developed by the multidisciplinary American College of Radiology VI-RADS Steering Committee, the VI-RADS Quality Score. It provides stratification of quality scores-inadequate, adequate, and optimal-based on signal-to-noise ratio, ability to clearly visualize relevant anatomic landmarks, and assessments of common imaging artifacts, which can guide clinical decision-making. It also emphasizes per-sequence scores in addition to an overall assessment to support targeted MRI protocol optimization. The VI-RADS Quality Score will need to be prospectively validated and will facilitate reproducibility across institutions, build trust in bladder MRI within multidisciplinary teams, and accelerate widespread adoption of bladder MRI for bladder cancer imaging. KEY POINTS: Question While high-quality bladder MRI is essential for evaluating bladder cancer, no universal scoring system is established for quality assessment. Findings A systematic review showed that studies on bladder MRI quality had significant variability. A structured scoring system was developed by the multidisciplinary VI-RADS steering committee. Clinical relevance High-quality bladder MRI is essential for reliable evaluation of bladder cancer. The VI-RADS Steering Committee developed a scoring system for bladder MRI quality assessment. This is expected to facilitate reproducibility and build trust in bladder MRI within multidisciplinary teams.