Associations of Anatomical Location and Reader Experience With the Diagnostic Performance of Multiparametric MRI-Derived VI-RADS for Muscle Invasive Bladder Cancer: A Multicenter Multireader Study.
Abstract
Background
The associations of tumor location and reader experience with Vesical Imaging-Reporting and Data System (VI-RADS) performance remain unclear.
Purpose
To evaluate the associations of tumor location and reader experience with VI-RADS performance in detecting muscle-invasive bladder cancer (MIBC). STUDY TYPE Retrospective. SUBJECTS A total of 543 patients (464 males; mean age, 67.0 ± 12.1 years) with bladder cancer. FIELD STRENGTH/SEQUENCE 1.5 T and 3.0 T, T2-weighted image with turbo spin-echo, diffusion-weighted imaging using single-shot echo planar imaging, and three-dimensional T1-weighted spoiled gradient echo sequence. ASSESSMENT Four radiologists (two with 15 and 10 years of experience and two with < 5 years of experience) independently assigned VI-RADS scores. Histopathology was the reference standard. Diagnostic performance of VI-RADS ≥ 3 for identifying MIBC was assessed across seven anatomical locations: trigone, ureteral orifice, neck, lateral wall, dome, anterior and posterior walls. STATISTICAL TESTS Weighted kappa, Generalized estimating equation (GEE) models, the independent samples t-test or Mann-Whitney U test, the chi-square test, ROC analysis and DeLong test. Benjamini-Hochberg false discovery rate (FDR)-adjust p < 0.05 was considered statistically significant.
Results
Of 543 patients, 168 (30.9%) had MIBC. Inter-reader agreement was excellent (κ = 0.943-0.986). Adjusted GEE models showed lower accuracy (OR, 0.624; 95% CI: 0.518-0.751) for inexperienced readers. Tumor location was not associated with overall accuracy (global p = 0.295), and the location-by-experience interaction was nonsignificant (global p = 0.469). The ureteral orifice showed the highest false-negative rates (24/82 [29.3%] and 32/82 [39.0%], respectively) in experienced and inexperienced readers, whereas the dome showed the highest false-positive rates (10/58 [17.2%] and 15/58 [25.9%], respectively). Only the lateral-wall false-positive rate differed significantly by experience (6.1% vs. 14.8%, respectively). DATA
Conclusion
Reader experience was independently associated with overall VI-RADS performance, whereas tumor location was not associated with overall accuracy. Descriptive analyses identified location-specific diagnostic pitfalls. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE 2.