Ricerc@Sapienza

The Vesical Imaging Reporting and Data System (VI-RADS) criteria are expanding, providing fine differentiation of bladder wall layers involvement. Up to now, VI-RADS has proved to be able to address this critical yet unsolved topic, including standardized criteria for reporting the imaging outcomes reflecting differences across cT stages, high inter-readers agreement, and high diagnostic accuracy for MIBC. However, it has been validated solely in the pre-TURBT setting. Instead, the body of evidence for the widespread use in the of MRI clinical practice for response to therapy assessment and prediction is growing, nonetheless it needs to be reinforced; our research is born from these necessities.
We aimed at exploring the feasibility of a novel categorical scoring, born from VI-RADS: the Neoadjuvant chemotherapy VI-RADS (nacVI-RADS) for radiologic assessment of response (RaR), to define the spectrum of treatment response among patients with muscle invasive bladder cancer (MIBC). Patients diagnosed with non-metastatic MIBC will be addressed to NAC and mpMRI before staging resection and after the chemotherapy cycles. The follow-up MRI assessment will be performed using the nacVI-RADS algorithm for evaluation of response to therapy. NacVI-RADS categorically define complete RaR, based on prior VI-RADS score, presence of residual disease, tumor size and infiltration of the muscularis propria. We foresee that NacVI-RADS categories will be able to match the final radical cystectomy pathology both for complete pT0 responders and for the patients defined as partial or minimal responders, who only showed some RaR inter-scoring class downstaging. The findings might lead to possible paradigmatic shifts for cancer-specific survival risk assessment and to possibly drive the therapeutic decision through active surveillance programs, bladder sparing modalities or to the standard of care.