Multiparametric Magnetic Resonance Imaging and Vesical Imaging-Reporting and Data System (VI-RADS) for Bladder Cancer Diagnosis and Staging: A Guide for Clinicians from the American College of Radiology VI-RADS Steering Committee

BACKGROUND AND OBJECTIVE: Staging of bladder cancer (BC) remains a cornerstone of treatment planning, especially in distinguishing non-muscle-invasive BC (NMIBC) from muscle-invasive BC (MIBC). Multiparametric magnetic resonance imaging (mpMRI), together with the Vesical Imaging-Reporting and Data System (VI-RADS) and its neoadjuvant chemotherapy version (nacVI-RADS), has emerged as a noninvasive, standardised tool for local staging and response assessment. Our aim was to provide urologists with a practical, up-to-date overview of bladder mpMRI and its application in diverse clinical settings. METHODS: We conducted a narrative review of the literature, including original studies, meta-analyses, international guidelines, and expert consensus documents, on the role of magnetic resonance imaging (MRI) in the BC diagnostic and therapeutic pathway. KEY FINDINGS AND LIMITATIONS: mpMRI with VI-RADS improves the accuracy of preoperative staging, helps in avoiding repeat transurethral resection of bladder tumour in selected NMIBC cases, and supports decision-making in MIBC in MRI-based pathways. nacVI-RADS allows assessment of treatment responses after systemic therapies, and can potentially guide bladder-sparing approaches. Barriers include variability in access, guideline inconsistency, the reproducibility of interpretation, and limited cost-effectiveness data. However, ongoing multicentre validation efforts and standardised reporting are helping to mitigate these issues. CONCLUSIONS AND CLINICAL IMPLICATIONS: mpMRI, VI-RADS, and nacVI-RADS represent essential tools for enhancing risk stratification and personalising BC management in clinical urology practice. Their integration into multidisciplinary workflows has the potential to improve outcomes and reduce overtreatment.