Diagnostic Accuracy of Multiparametric MRI in Differentiating Non-Muscle-Invasive from Muscle-Invasive Urinary Bladder Cancer Using Histopathology as the Gold Standard
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1230Abstract
Background: Accurate preoperative staging of urinary bladder cancer is essential for appropriate treatment planning and improved patient outcomes. While cystoscopy with biopsy remains the gold standard, it is invasive and has limitations in assessing tumor depth and extravesical extension. Magnetic resonance imaging (MRI), particularly multiparametric MRI, offers superior soft tissue contrast and the ability to differentiate bladder wall layers, making it a promising non-invasive alternative.
Objective: To determine the diagnostic accuracy of MRI in differentiating non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC), using histopathology as the gold standard.
Methodology: This cross-sectional validation study included 160 patients aged 25–65 years with suspected bladder cancer. MRI was performed using a 1.5-T system, and findings were interpreted by an experienced radiologist. Histopathological examination following transurethral resection of bladder tumor (TURBT) served as the reference standard. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated.
Results: MRI demonstrated a sensitivity of 92.13%, specificity of 90.14%, PPV of 92.13%, NPV of 90.14%, and an overall diagnostic accuracy of 91.25% in differentiating NMIBC from MIBC.
Conclusion: Multiparametric MRI shows high diagnostic accuracy and can serve as a reliable non-invasive modality for differentiating muscle-invasive from non-muscle-invasive bladder cancer, thereby aiding in clinical decision-making and treatment planning.
Keywords: Bladder cancer, Diagnostic accuracy, Magnetic resonance imaging, Sensitivity, Specificity.
References
Liu P, Cai L, Jiang L, Zhang Y, Wang X, Chen Z, et al. Comparative diagnostic performance of VI-RADS based on biparametric and multiparametric MRI in predicting muscle invasion in bladder cancer. BMC Med Imaging. 2025;25:60. https://doi.org/10.1186/s12880-025-01595-3
He K, Zhang Y, Li Q, Liu X, Wang J, Zhao H, et al. Progress of multiparameter magnetic resonance imaging in assessing muscle invasion of bladder cancer. Diagnostics (Basel). 2024;14(4):442. https://doi.org/10.3390/diagnostics14040442
Kim SH, Han JH, Jeong SH, Park SY, Lee HJ, Lee YJ, et al. Accuracy of stage prediction using the vesical imaging reporting and data system before radical cystectomy for urothelial carcinoma. Transl Androl Urol. 2023;12(2):168-175. https://doi.org/10.21037/tau-22-704
Jai-Ua C, Limpaiboon C, Siriboonrid S, Thongprayoon C, Mao MA, Cheungpasitporn W, et al. Accuracy of vesical imaging-reporting and data system for muscle-invasive bladder cancer detection using multiparametric MRI. Investig Clin Urol. 2023;64(6):546-553. https://doi.org/10.4111/icu.20230120
Aslan S, Ta?demir M, Çakir E, Karagöz Y, Demir M, Ayd?n H, et al. Predicting variant histology in bladder cancer: the role of multiparametric MRI and vesical imaging-reporting and data system (VI-RADS). Abdom Radiol (NY). 2025;50:4700-4711. https://doi.org/10.1007/s00261-025-04852-9
Reddy BV, Sharma A, Singh A, Gupta S, Kumar P, Jain R, et al. Performance and clinical implications of VI-RADS scoring with multiparametric MRI for bladder cancer staging. Indian J Urol. 2024;40(4):310-316. https://doi.org/10.4103/iju.iju_202_24
Makboul M, Farghaly S, Abdelkawi IF. Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application. Br J Radiol. 2019;92(1104):20190401. https://doi.org/10.1259/bjr.20190401
Lee M, Shin SJ, Oh YT, Jung DC, Cho NH, Choi YD, et al. Non-contrast magnetic resonance imaging for bladder cancer: fused high b-value diffusion-weighted imaging and T2-weighted imaging helps evaluate depth of invasion. Eur Radiol. 2017;27(9):3752-3758. https://doi.org/10.1007/s00330-017-4753-x
Cornelissen SWE, Veenboer PW, Wessels FJ, Meijer RP. Diagnostic accuracy of multiparametric MRI for local staging of bladder cancer: a systematic review and meta-analysis. Urology. 2020;145:22-29. https://doi.org/10.1016/j.urology.2020.07.031
Zhang X, Liu Y, Wang H, Chen Z, Zhao X, Sun Y, et al. Differentiation of muscular invasion in bladder cancer using synthetic MRI and T2 relaxation time analysis. Eur J Radiol. 2024;173:111445. https://doi.org/10.1016/j.ejrad.2024.111445
Nesiu A, Popescu R, Balanescu P, Ciortea CA, Badea R, Botar-Jid C, et al. Diagnostic performance and interobserver agreement of VI-RADS for distinguishing muscle-invasive from non-muscle-invasive bladder cancer: a systematic review. Medicina (Kaunas). 2025;61(3):469. https://doi.org/10.3390/medicina61030469
El-Assmy A, Abou-El-Ghar ME, Mosbah A. Bladder tumour staging: comparison of diffusion- and T2-weighted MR imaging. Eur Radiol. 2009;19(7):1575-1581. https://doi.org/10.1007/s00330-009-1340-z
Takeuchi M, Sasaki S, Ito M, Okada S, Takahashi S, Kawai T, et al. Urinary bladder cancer: diffusion-weighted MR imaging—accuracy for diagnosing T stage and estimating histologic grade. Radiology. 2009;251(1):112-121. https://doi.org/10.1148/radiol.2511080873
Wu LM, Chen XX, Xu JR, Zhang YL, Wang J, Guan YB, et al. Clinical value of T2-weighted imaging combined with diffusion-weighted imaging in preoperative T staging of urinary bladder cancer: a large-scale multiobserver prospective study on 3.0-T MRI. Acad Radiol. 2013;20(8):939-946. https://doi.org/10.1016/j.acra.2013.03.006
Kobayashi S, Koga F, Yoshida S, Masuda H, Ishii C, Tanaka H, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in bladder cancer: potential utility of apparent diffusion coefficient values as a biomarker to predict clinical aggressiveness. Eur Radiol. 2011;21(10):2178-2186. https://doi.org/10.1007/s00330-011-2169-7
Thoeny HC, Froehlich JM, Triantafyllou M, Birkhäuser FD, Vermathen P, Studer UE. Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology. 2014;273(1):125-135. https://doi.org/10.1148/radiol.14132921
Woo S, Panebianco V, Narumi Y, Del Giudice F, Muglia VF, Takeuchi M, et al. Diagnostic performance of the vesical imaging reporting and data system for predicting muscle-invasive bladder cancer: a systematic review and meta-analysis. Eur Urol Oncol. 2021;4(6):957-968. https://doi.org/10.1016/j.euo.2020.11.001
Wang HJ, Pui MH, Guo Y, Guan J, Zhang XL, Pan YT, et al. Diagnostic performance of VI-RADS for prediction of muscle-invasive bladder cancer: systematic review and meta-analysis. AJR Am J Roentgenol. 2022;218(4):744-752. https://doi.org/10.2214/AJR.21.26341
van der Pol CB, Chung A, Lim C, Gandhi N, Tu W, McInnes MDF, et al. Accuracy of the vesical imaging reporting and data system for predicting muscle invasion in bladder cancer using multiparametric MRI. Eur Radiol. 2022;32(5):3500-3510. https://doi.org/10.1007/s00330-021-08327-0
Yamada Y, Kobayashi S, Isoshima S, Arima K, Sakuma H, Sugimura Y. The usefulness of diffusion-weighted magnetic resonance imaging in bladder cancer staging and functional analysis. J Cancer Res Ther. 2014;10(4):878-882. https://doi.org/10.4103/0973-1482.145844
Daneshmand S, Ahmadi H, Huynh LN, Dobos N. Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: results from a prospective study. Urology. 2012;80(6):1313-1318. https://doi.org/10.1016/j.urology.2012.08.026
Cao B, Li J, Zhang Y, Wang H, Liu Y, Chen Z, et al. Vesical imaging-reporting and data system (VI-RADS) as a predictor of bladder cancer staging and grading using multiparametric MRI. Clin Radiol. 2024;79(10):e746-e753. https://doi.org/10.1016/j.crad.2024.05.012
Selvaraju A, Taylor J, Smith C, Brown M, Wilson R, Ahmed HU, et al. Preoperative prediction of muscle invasion in bladder cancer using multiparametric MRI and VI-RADS: prospective validation study. Clin Radiol. 2025;80(5):e301-e308. https://doi.org/10.1016/j.crad.2025.01.004
Panebianco V, Narumi Y, Del Giudice F, Barchetti G, Pecoraro M, Catalano C, et al. Multiparametric magnetic resonance imaging for bladder cancer: current role and future perspectives. Eur Urol Oncol. 2025;8(1):1-10. https://doi.org/10.1016/j.euo.2024.11.003
Al-Qudimat AR, Al-Shalabi M, Al-Khawaldeh M, Al-Ryalat N, Al-Domi H, Al-Qudah A, et al. Implementing the VI-RADS score for image-guided assessment of muscle-invasive bladder cancer: systematic review and meta-analysis. World J Urol. 2024;42(1):1-12. https://doi.org/10.1007/s00345-024-04376-5
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
