AI-driven and Traditional Radiomic Model for Predicting Muscle Invasion in Bladder Cancer via Multi-parametric Imaging: A Systematic Review and Meta-analysis.

Rationale And Objectives: This study systematically evaluates the diagnostic performance of artificial intelligence (AI)-driven and conventional radiomics models in detecting muscle-invasive bladder cancer (MIBC) through meta-analytical approaches. Furthermore, it investigates their potential synergistic value with the Vesical Imaging-Reporting and Data System (VI-RADS) and assesses clinical translation prospects.

Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a comprehensive systematic search of PubMed, Web of Science, Embase, and Cochrane Library databases up to May 13, 2025, and manually screened the references of included studies. The quality and risk of bias of the selected studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Radiomics Quality Score (RQS) tools. We pooled the area under the curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and their 95% confidence intervals (95% CI). Additionally, meta-regression and subgroup analyses were performed to identify potential sources of heterogeneity.

Results: This meta-analysis incorporated 43 studies comprising 9624 patients. The majority of included studies demonstrated low risk of bias, with a mean RQS of 18.89. Pooled analysis yielded an AUC of 0.92 (95% CI: 0.89-0.94). The aggregate sensitivity and specificity were both 0.86 (95% CI: 0.84-0.87), with heterogeneity indices of I² = 43.58 and I² = 72.76, respectively. The PLR was 5.97 (95% CI: 5.28-6.75, I² = 64.04), while the NLR was 0.17 (95% CI: 0.15-0.19, I² = 37.68). The DOR reached 35.57 (95% CI: 29.76-42.51, I² = 99.92). Notably, all included studies exhibited significant heterogeneity (P < 0.1). Meta-regression and subgroup analyses identified several significant sources of heterogeneity, including: study center type (single-center vs. multi-center), sample size (<100 vs. ≥100 patients), dataset classification (training, validation, testing, or ungrouped), imaging modality (computed tomography [CT] vs. magnetic resonance imaging [MRI]), modeling algorithm (deep learning vs. machine learning vs. other), validation methodology (cross-validation vs. cohort validation), segmentation method (manual vs. [semi]automated), regional differences (China vs. other countries), and risk of bias (high vs. low vs. unclear).

Conclusion: AI-driven and traditional radiomic models have exhibited robust diagnostic performance for MIBC. Nevertheless, substantial heterogeneity across studies necessitates validation through multinational, multicenter prospective cohort studies to establish external validity.