Magnetic Resonance Imaging protocol for bladder evaluation: systematic review of the Scientific Literature and clinical application

Abstract

Bladder cancer is among the most prevalent urological malignancies, and accurate assessment of detrusor muscle invasion is essential for therapeutic decision-making and prognostic stratification. Multiparametric Magnetic Resonance Imaging (mpMRI), standardized by the Vesical Imaging Reporting and Data System (VI-RADS), has emerged as the reference imaging modality for local staging, with the primary aim of differentiating non–muscle-invasive from muscle-invasive bladder cancer prior to transurethral resection. This systematic review aimed to evaluate the MRI acquisition protocol recommended by the VI-RADS system, with particular emphasis on sequence selection and technical parameters. In addition, the clinical applicability of the protocol was assessed through its implementation in routine clinical practice. The review was conducted in accordance with PRISMA 2020 guidelines. A systematic literature search was performed in PubMed/MEDLINE, Embase, Scopus, and Web of Science for studies published from 2017 onward, including patients with bladder cancer who underwent mpMRI according to VI-RADS criteria. Eleven studies met the inclusion criteria. All employed high-field MRI systems and multiparametric protocols based on T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced sequences. Overall, adherence to the VI-RADS acquisition protocol was consistently associated with high sensitivity and specificity for the detection of detrusor muscle invasion. In conclusion, VI-RADS–based mpMRI represents a reliable and reproducible approach for local staging of bladder cancer. Proper standardization of acquisition parameters and optimization of image quality are critical to maximizing diagnostic accuracy and ensuring robust clinical applicability.