The learning curve in bladder MRI using VI-RADS assessment score during an interactive dedicated training program

Effect of accumulating experience on diagnostic performance of VI-RADS in bladder cancer

PURPOSE

MRI-based VI-RADS score aids in differentiating MIBC and NMIBC, but the experience's impact remains unexplored. We aimed to determine the effect of accumulating experience in the diagnostic performance of VI-RADS.

METHODS

In our previously published series 71 primary bladder cancer patients who underwent multiparametric MRI before the transurethral resection were analyzed. The radiologist who assessed the VI-RADS scores at the time the study was performed, re-evaluated all cases after 3 years, in a blinded fashion. During these three years, more than 300 additional bladder MRIs were performed for VI-RADS assessment. The diagnostic performances of the initial and subsequent VI-RADS analyses were compared. Moreover, VIRADS results obtained by a newly trained abdominal radiologist was also compared with experienced radiologist's results. For this study, VI-RADS ≥3 was accepted for predicting MIBC.

RESULTS

Overall 71 patients [62 (87.3 %) males, 67.4 ± 10.2 years] who underwent bladder MRI before TURBT were included. Histopathology revealed MIBC in 16 (26.2 %) cases. The initial MRI analysis revealed VI-RADS score ≥ 3 in 36 (50.7 %) cases. The sensitivity and specificity for depicting MIBC were 75 % and 56.4 % respectively. The subsequent MRI analysis revealed VI-RADS score ≥ 3 in 23 (32.4 %) cases. The sensitivity and specificity were 93.8 % and 85.5 % respectively. The MRI analysis performed by the recently trained abdominal radiologist revealed VI-RADS score ≥ 3 in 24 (33.8 %) cases. The sensitivity and specificity were 87.5 % and 56.4 % respectively.

CONCLUSION

The diagnostic performance of VI-RADS for the interpretation of bladder MRI can improve over time by increasing the experience of the urogenital radiologist.

Quantifying Radiology Residents' Learning Curves in Report Writing Performance Through Report Comparison and Jaccard Similarity

Background Report writing skills are a core competency to be acquired during residency, yet objective tools for tracking performance are lacking. Purpose To investigate whether the Jaccard index, derived from report comparison, can objectively illustrate learning curves in report writing performance throughout radiology residency. Materials and Methods Retrospective data from 246 984 radiology reports written from September 2017 to November 2022 in a tertiary care radiology department were included. Reports were scored using the Jaccard similarity coefficient (ie, a quantitative expression of the amount of edits performed; range, 0-1) of residents' draft (unsupervised initial attempt at a complete report) or preliminary reports (following joint readout with attending physicians) and faculty-reviewed final reports. Weighted mean Jaccard similarity was compared between years of experience using Welch analysis of variance with post hoc testing overall, per imaging division, and per modality. Relationships with years and quarters of resident experience were assessed using Spearman correlation. Results This study included 53 residents (mean report count, 4660 ± 3546; 1-5 years of experience). Mean Jaccard similarity of preliminary reports increased by 6% from 1st-year to 5th-year residents (0.86 ± 0.22 to 0.92 ± 0.15; P < .001). Spearman correlation demonstrated a strong relationship between residents' experience and higher report similarity when aggregated for years (rs = 0.99 [95% CI: 0.85, 1.00]; P < .001) or quarters of experience (rs = 0.90 [95% CI: 0.73, 0.96]; P < .001). For residents' draft reports, Jaccard similarity increased by 14% over the course of the 5-year residency program (0.68 ± 0.27 to 0.82 ± 0.23; P < .001). Subgroup analysis confirmed similar trends for all imaging divisions and modalities (eg, in musculoskeletal imaging, from 0.77 ± 0.31 to 0.91 ± 0.16 [P < .001]; rs = 0.98 [95% CI: 0.72, 1.00] [P < .001]). Conclusion Residents' report writing performance increases with experience. Trends can be quantified with the Jaccard index, with a 6% improvement from 1st- to 5th-year residents, indicating its effectiveness as a tool for evaluating training progress and guiding education over the course of residency. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Bruno in this issue.

Training radiology residents to evaluate deep myometrial invasion in endometrial cancer patients on MRI: A learning curve study

PURPOSE

To evaluate the impact of a four-month training program on radiology residents' diagnostic accuracy in assessing deep myometrial invasion (DMI) in endometrial cancer (EC) using MRI.

METHOD

Three radiology residents with limited EC MRI experience participated in the training program, which included conventional didactic sessions, case-centric workshops, and interactive classes. Utilizing a training dataset of 120 EC MRI scans, trainees independently assessed subsets of cases over five reading sessions. Each subset consisted of 30 scans, the first and the last with the same cases, for a total of 150 reads. Diagnostic accuracy metrics, assessment time (rounded to the nearest minute), and confidence levels (using a 5-point Likert scale) were recorded. The learning curve was obtained plotting the diagnostic accuracy of the three trainees and the average over the subsets. Anatomopathological results served as the reference standard for DMI presence.

RESULTS

The three trainees exhibited heterogeneous starting point, with a learning curve and a trend to more homogeneous performance with training. The diagnostic accuracy of the average trainee raised from 64 % (56 %-76 %) to 88 % (80 %-94 %) across the five subsets (p < 0.001). Reductions in assessment time (5.92 to 4.63 min, p < 0.018) and enhanced confidence levels (3.58 to 3.97, p = 0.12) were observed. Improvements in sensitivity, specificity, positive predictive value, and negative predictive value were noted, particularly for specificity which raised from 56 % (41 %-68 %) in the first to 86 % (74 %-94 %) in the fifth subset (p = 0.16). Although not reaching statistical significance, these advancements aligned the trainees with literature performance benchmarks.

CONCLUSIONS

The structured training program significantly enhanced radiology residents' diagnostic accuracy in assessing DMI for EC on MRI, emphasizing the effectiveness of active case-based training in refining oncologic imaging skills within radiology residency curricula.

What the urologist needs to know before radical prostatectomy: MRI effective support to pre-surgery planning

BACKGROUND

Radical prostatectomy (RP) is recommended in case of localized or locally advanced prostate cancer (PCa), but it can lead to side effects, including urinary incontinence (UI) and erectile dysfunction (ED). Magnetic resonance imaging (MRI) is recommended for PCa diagnosis and staging, but it can also improve preoperative risk-stratification.

PURPOSE

This nonsystematic review aims to provide an overview on factors involved in RP side effects, highlighting anatomical and pathological aspects that could be included in a structured report.

EVIDENCE SYNTHESIS

Considering UI evaluation, MR can investigate membranous urethra length (MUL), prostate volume, the urethral sphincter complex, and the presence of prostate median lobe. Longer MUL measurement based on MRI is linked to a higher likelihood of achieving continence restoration. For ED assessment, MRI and diffusion tensor imaging identify the neurovascular bundle and they can aid in surgery planning. Finally, MRI can precisely describe extra-prostatic extension, prostate apex characteristics and lymph-node involvement, providing valuable preoperative information for PCa treatment.

CONCLUSIONS

Anatomical principals structures involved in RP side effects can be assessed with MR. A standardized MR report detailing these structures could assist urologists in planning optimal and tailored surgical techniques, reducing complications, and improving patients' care.

Clinical application of bladder MRI and the Vesical Imaging-Reporting and Data System

Diagnostic work-up and risk stratification in patients with bladder cancer before and after treatment must be refined to optimize management and improve outcomes. MRI has been suggested as a non-invasive technique for bladder cancer staging and assessment of response to systemic therapy. The Vesical Imaging-Reporting And Data System (VI-RADS) was developed to standardize bladder MRI image acquisition, interpretation and reporting and enables accurate prediction of muscle-wall invasion of bladder cancer. MRI is available in many centres but is not yet recommended as a first-line test for bladder cancer owing to a lack of high-quality evidence. Consensus-based evidence on the use of MRI-VI-RADS for bladder cancer care is needed to serve as a benchmark for formulating guidelines and research agendas until further evidence from randomized trials becomes available.

Training the New Radiologists: Approaches for Education

The field of Radiology is continually changing, requiring corresponding evolution in both medical student and resident training to adequately prepare the next generation of radiologists. With advancements in adult education theory and a deeper understanding of perception in imaging interpretation, expert educators are reshaping the training landscape by introducing innovative teaching methods to align with increased workload demands and emerging technologies. These include the use of peer and interdisciplinary teaching, gamification, case repositories, flipped-classroom models, social media, and drawing and comics. This publication aims to investigate these novel approaches and offer persuasive evidence supporting their incorporation into the updated Radiology curriculum.

Progress of Multiparameter Magnetic Resonance Imaging in Bladder Cancer: A Comprehensive Literature Review

Magnetic resonance imaging (MRI) has been proven to be an indispensable imaging method in bladder cancer, and it can accurately identify muscular invasion of bladder cancer. Multiparameter MRI is a promising tool widely used for preoperative staging evaluation of bladder cancer. Vesical Imaging-Reporting and Data System (VI-RADS) scoring has proven to be a reliable tool for local staging of bladder cancer with high accuracy in preoperative staging, but VI-RADS still faces challenges and needs further improvement. Artificial intelligence (AI) holds great promise in improving the accuracy of diagnosis and predicting the prognosis of bladder cancer. Automated machine learning techniques based on radiomics features derived from MRI have been utilized in bladder cancer diagnosis and have demonstrated promising potential for practical implementation. Future work should focus on conducting more prospective, multicenter studies to validate the additional value of quantitative studies and optimize prediction models by combining other biomarkers, such as urine and serum biomarkers. This review assesses the value of multiparameter MRI in the accurate evaluation of muscular invasion of bladder cancer, as well as the current status and progress of its application in the evaluation of efficacy and prognosis.

Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): a real-world study

OBJECTIVES

Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting.

METHODS

Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed.

RESULTS

Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS ≥3 and ≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS ≥3 and ≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (κ = 0.45).

CONCLUSION

VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate.

MRI-Based Radiomics in Bladder Cancer: A Systematic Review and Radiomics Quality Score Assessment

(1): Background: With the recent introduction of vesical imaging reporting and data system (VI-RADS), magnetic resonance imaging (MRI) has become the main imaging method used for the preoperative local staging of bladder cancer (BCa). However, the VI-RADS score is subject to interobserver variability and cannot provide information about tumor cellularity. These limitations may be overcome by using a quantitative approach, such as the new emerging domain of radiomics. (2) Aim: To systematically review published studies on the use of MRI-based radiomics in bladder cancer. (3) Materials and Methods: We performed literature research using the PubMed MEDLINE, Scopus, and Web of Science databases using PRISMA principles. A total of 1092 papers that addressed the use of radiomics for BC staging, grading, and treatment response were retrieved using the keywords "bladder cancer", "magnetic resonance imaging", "radiomics", and "textural analysis". (4) Results: 26 papers met the eligibility criteria and were included in the final review. The principal applications of radiomics were preoperative tumor staging (n = 13), preoperative prediction of tumor grade or molecular correlates (n = 9), and prediction of prognosis/response to neoadjuvant therapy (n = 4). Most of the developed radiomics models included second-order features mainly derived from filtered images. These models were validated in 16 studies. The average radiomics quality score was 11.7, ranging between 8.33% and 52.77%. (5) Conclusions: MRI-based radiomics holds promise as a quantitative imaging biomarker of BCa characterization and prognosis. However, there is still need for improving the standardization of image preprocessing, feature extraction, and external validation before applying radiomics models in the clinical setting.

Role of Multiparametric-MRI in Bladder Cancer

Purpose of Review

This narrative review article aims to show the actual role of imaging, in particular MRI, and the role of VI-RADS Score, in recognition and follow-up of the tumor.

Recent Findings

A team of professionals created VI-RADS with the goal of standardizing the acquisition and interpretation of multiparametric-MRI in bladder cancer.

Summary

Bladder cancer is the most common cancer involving the urinary system. It is the fourth most common urological cancer in men and the second most frequent cancer affecting the urinary tract. Main risks factors are advanced age, male sex, and cigarette smoking. Bladder cancer ranges from unaggressive and usually non-invasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. At the time of diagnosis, 70% of patients are experiencing non-muscle-invasive bladder cancer. Vesical imaging-reporting and data system score (VI-RADS) is a scoring system useful to standardize the approach to multiparametric-MRI interpretation, and reporting for bladder cancer.