# VI-RADS — Vesical Imaging Reporting and Data System

> Multiparametric MRI risk stratification of bladder cancer muscle invasion.

**Situação:** vigente · **Órgão:** Bexiga · **Órgão emissor:** VI-RADS working group · **Versão:** 2018 · **Ano:** 2018

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Panebianco V, Narumi Y, Altun E, et al.. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6690492/
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 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). | 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. | 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). | 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. | 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. | 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. | ✓ |

### Citações por categoria
- **1**: Panebianco V, Narumi Y, Altun E, et al.. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6690492/ · 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**: Panebianco V, Narumi Y, Altun E, et al.. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6690492/ · 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**: Panebianco V, Narumi Y, Altun E, et al.. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6690492/ · 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**: Panebianco V, Narumi Y, Altun E, et al.. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6690492/ · 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**: Panebianco V, Narumi Y, Altun E, et al.. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System) (2018) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6690492/ · 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. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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