Diagnostic accuracy of the Vesical Imaging Reporting and Data System for muscle-invasive bladder cancer and its role in reducing repeat transurethral resection of bladder tumor: A systematic review.

Background: The Vesical Imaging Reporting and Data System (VI-RADS) has been introduced as a standardized tool for assessing multiparametric magnetic resonance imaging (MRI) in the pre-operative staging of bladder cancer. Objective: The present systematic review evaluates the efficacy of VI-RADS in diagnosing muscle-invasive bladder cancer (MIBC) compared with established diagnostic techniques. A systematic review was conducted according to PRISMA guidelines using PubMed, Scopus, and Web of Science. Studies assessing VI-RADS for MIBC diagnosis were included if they reported sensitivity, specificity, area under the curve, and comparisons with conventional approaches. Study characteristics, sample size, VI-RADS cutoff, diagnostic performance, and risk of bias were evaluated. Thirteen studies (sample sizes ranging from 18 to 340) demonstrated high diagnostic performance, with sensitivity ranging from 78% to 100%, specificity from 73% to 96%, and AUC from 0.86 to 0.96. VI-RADS outperformed standard assessment in reducing transurethral resection of bladder tumor (TURBT)-related understaging. A forest plot showed variability in sensitivity, influenced by radiologist experience, magnetic resonance imaging protocols, and study design. The risk of bias was moderate-to-low. Conclusion: VI-RADS is an effective non-invasive tool for detecting MIBC and plays an important role in pre-operative decision-making. It may reduce the need for repeat TURBT. Standardization of MRI protocols and radiologist training is vital to improve diagnostic reliability.