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

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.

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.

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.

Published by European urology, 2026. The guideline itself is at the source linked here.

doi.org/10.1016/j.eururo.2025.10.010