VI-RADS · Bexiga

VI-RADS Vesical Imaging Reporting and Data System

vigente

Multiparametric MRI risk stratification of bladder cancer muscle invasion.

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Escala de categorias

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Procedência e vigência

Órgão emissor: VI-RADS working group
Versão: 2018
Ano: 2018
Família: léxico
Tipo de lógica: flat
Modalidade: MRI
Fonte primária: Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) · doi:10.1016/j.eururo.2018.04.029
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

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{
  "categories": [
    "1",
    "2",
    "3",
    "4",
    "5"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
1	VI-RADS 1, muscle invasion highly unlikely Muscle invasion highly unlikely. All sequences are category 1: on T2WI an uninterrupted low-signal line indicates an intact muscularis propria; on DWI the muscle layer shows continuous intermediate signal (lesion under 1 cm); on DCE there is no early enhancement of the muscularis propria.	Below the validated VI-RADS >=3 muscle-invasion cutoff: low-probability lesion managed as non-muscle-invasive disease (e.g. transurethral resection / TURBT) rather than treated as muscle-invasive; multiparametric MRI reduces the need for upfront re-resection.	Muscle invasion highly unlikely; in validation studies, scores of 1-2 correspond to a low probability of muscle-invasive bladder cancer, well below the >=3 threshold (pooled sensitivity ~0.87-0.92 / specificity ~0.82-0.86 for the >=3 cutoff).	okfonte PMC6690492 (Panebianco et al., Eur Urol 2018), Sect. 3.2.5 'Final scoring' with 3.2.4.2/3.2.4.3/3.2.4.4; Table 2 (criteria, 'muscle invasion highly unlikely'). Cutoff/performance from validation meta-analysis summarized in PMC10493860 (VI-RADS >=3 optimal cutoff).
2	VI-RADS 2, muscle invasion unlikely Muscle invasion unlikely. The low-signal muscularis line remains uninterrupted; typically an exophytic tumor with a stalk and/or a thickened high-signal inner layer on T2WI, with corresponding category-2 DWI/DCE (continuous intermediate-signal muscle on DWI for lesions over 1 cm; early enhancement of the inner layer but not the muscle on DCE).	Below the >=3 cutoff: treated as non-muscle-invasive disease. For a small T1 tumor with a clear stalk and no muscularis-propria involvement the goal is a complete (radical) TURBT, generally without mandatory re-resection.	Muscle invasion unlikely; scores 1-2 carry a low probability of muscle-invasive cancer and fall below the >=3 muscle-invasion threshold in validation studies.	okfonte PMC6690492, Sect. 3.2.5 with 3.2.4.2/3.2.4.3/3.2.4.4; Table 2; TURBT-goal statement from Sect. 3.3.2 ('radical TURBT should be the goal' for stalked T1). Cutoff context from PMC10493860.
3	VI-RADS 3, equivocal Equivocal for muscle invasion. Category-2 features are absent but there is no clear interruption of the low-signal muscularis propria (e.g. exophytic tumor lacking a stalk, or a sessile/broad-based tumor without a clearly thickened inner layer). When T2WI is equivocal, DWI (first) then DCE drive the assessment.	Equivocal zone at the validated >=3 cutoff: warrants careful surgical planning — a deeper-invading T1 tumor (T1b/c) makes a mandatory re-TUR appropriate, and clinicians should weigh treating as potentially muscle-invasive.	Equivocal probability of muscle invasion. VI-RADS 3 is the validated 'watershed' cutoff: using score >=3 to predict muscle invasion gives pooled sensitivity ~0.87-0.92 and specificity ~0.82-0.86 (about 90% accuracy in prospective cohorts).	okfonte PMC6690492, Sect. 3.2.5 ('equivocal') with 3.2.4.2/3.2.4.3/3.2.4.4 and Table 2; re-TUR statement from Sect. 3.3.2 ('re-TUR should be mandatory' for T1b/c). >=3 cutoff performance from validation meta-analysis in PMC10493860.
4	VI-RADS 4, muscle invasion likely Muscle invasion likely. At least one sequence is category 4: on T2WI the low-signal muscularis line is interrupted, suggesting tumor extension into the muscularis propria; DWI shows high-signal tumor (low ADC) extending focally into the muscle; DCE shows early-enhancing tumor extending focally into the muscularis propria.	At/above the muscle-invasion cutoff: high suspicion of muscle-invasive bladder cancer; supports treating as muscle-invasive disease and proceeding toward definitive staging/management (e.g. radical cystectomy pathway) rather than relying on TURBT alone.	Muscle invasion likely; in validation studies a score >=4 is highly specific for muscle invasion (pooled specificity ~0.94-0.96, sensitivity ~0.78), i.e. high positive predictive value when present.	okfonte PMC6690492, Sect. 3.2.5 ('muscle invasion likely') with 3.2.4.2/3.2.4.3/3.2.4.4 and Table 2; >=4 cutoff specificity/sensitivity from validation meta-analysis in PMC10493860.
5	VI-RADS 5, invasion of or beyond muscle very likely Invasion of muscle and beyond the bladder very likely. Intermediate-signal tumor extends into the extravesical fat on T2WI; on DWI/DCE the high-signal or early-enhancing tumor extends through the entire bladder wall into the perivesical fat.	Very high suspicion of muscle-invasive (and extravesical) disease: managed along the muscle-invasive/advanced pathway with definitive staging and treatment (e.g. radical cystectomy +/- neoadjuvant chemotherapy as clinically indicated), not TURBT alone.	Invasion of muscle and beyond the bladder very likely; highest VI-RADS probability of muscle-invasive disease, well above the >=3 cutoff and within the high-specificity >=4 range.	okfonte PMC6690492, Sect. 3.2.5 ('invasion of muscle and beyond the bladder very likely') with 3.2.4.2/3.2.4.3/3.2.4.4 and Table 2; cutoff context from PMC10493860.

Histórico de versões

Data	Evento	Detalhe	Situação
2018-05-01	published	VI-RADS published in European Urology.	confirmado

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