The role of multiparametric MRI-based VI-RADS in predicting the need for a second TURB.

Purpose: To prospectively evaluate the value of Vesical Imaging Reporting and Data System (VI‑RADS) prior to initial transurethral resection of the bladder (TURB) in predicting residual tumor at second TURB and subsequent prognosis of patients.

Methods: We enrolled suspected bladder cancer patients and scheduled multiparametric magnetic resonance imaging (mpMRI) of bladder for them before initial TURB. Second TURB were conducted based on initial resection reports, with comparisons made between patients with VI-RADS scores <3 and ≥3 regarding residual tumor rate, recurrence-free survival (RFS) and progression-free survival (PFS). Predictive efficacy of VI-RADS was assessed using Chi-square tests, logistic and Cox regression analyses, ROC curves, and Kaplan-Meier analyses.

Results: A total of 108 patients were included, and residual tumors were detected in 25.0% (27/108) of them at second TURB, with a significant difference between patients with VI-RADS score <3 and ≥3 (8/81 vs. 19/27, p <0.001). VI-RADS ≥3 demonstrated a sensitivity of 70.4%, specificity of 90.1%, positive predictive value (PPV) of 70.4%, and negative predictive value (NPV) of 90.1%. Stratified analysis showed VI-RADS achieved a NPV of 95.2% for disease-free Ta patients, while 84.6% for T1 patients. After a median follow-up of 30 months for the 92 patients, 24 experienced tumor recurrence. VI-RADS ≥3 was found to be an independent predictor of tumor recurrence (HR = 4.297, p = 0.003).

Conclusions: VI-RADS ≥3 is associated with higher residual tumor rate at second TURB and higher recurrence risk. It might be an option for omitting second TURB when VI-RADS is <3, especially for Ta patients.