VI-RADS provides excellent diagnostic performance for determining muscle invasion in bladder cancer, with future updates needed to address biparametric MRI, quantitative metrics, and artificial intelligence.
Since the introduction of the Vesical Imaging-Reporting and Data System (VI-RADS), MRI has become an important imaging modality in the management of patients with bladder cancer. Its excellent diagnostic performance for determining muscle invasion in bladder cancer has been supported by numerous prospective and retrospective studies. Nevertheless, there needs to be continued improvement of the diagnostic performance of VI-RADS and sustained efforts to address remaining unmet clinical needs within the field of bladder cancer. In this paper, we highlight several such areas, some of which are actively being investigated. These include (1) whether to use intravenous contrast media or not (multiparametric vs. biparametric MRI), (2) quantitative metrics to enhance assessment of muscle invasion, (3) anatomic locations that come with pitfalls in staging, (4) introduction of bladder MRI image quality, (5) neoadjuvant chemotherapy VI-RADS (nacVI-RADS) and other considerations needed in the treatment response assessment after systemic therapies, (6) need for wider adoption, training, and implementation, and (7) application of artificial intelligence.
Woo et al. (2026) conducted a review in Bladder cancer. VI-RADS (Vesical Imaging-Reporting and Data System) was evaluated. VI-RADS provides excellent diagnostic performance for determining muscle invasion in bladder cancer, with future updates needed to address biparametric MRI, quantitative metrics, and artificial intelligence.