Multiparametric MRI in Era of Artificial Intelligence for Bladder Cancer Therapies

Simple Summary Bladder cancer is the sixth most common cancer in the United States. The prognosis is excellent for localized forms, but the survival rates drop significantly when cancer invades the smooth muscle of the bladder. Imaging is essential for the accurate staging, prognosis, and assessment of therapeutic efficacy in bladder cancer and has the potential to guide personalized treatment strategies. Computed tomography has traditionally been the standard modality, but magnetic resonance imaging (MRI) is the emerging technique of choice for its superior soft tissue contrast without exposure to ionizing radiation. Multiparametric (mp)MRI provides physiological data interrogating the biology of the tumor, as well as high-resolution anatomical images. Advanced MRI techniques have enabled new imaging-based clinical endpoints, including novel scoring systems for tumor staging. Artificial intelligence (AI) holds the potential for the automated discovery of clinically relevant patterns in mpMRI images of the bladder.Abstract This review focuses on the principles, applications, and performance of mpMRI for bladder imaging. Quantitative imaging biomarkers (QIBs) derived from mpMRI are increasingly used in oncological applications, including tumor staging, prognosis, and assessment of treatment response. To standardize mpMRI acquisition and interpretation, an expert panel developed the Vesical Imaging-Reporting and Data System (VI-RADS). Many studies confirm the standardization and high degree of inter-reader agreement to discriminate muscle invasiveness in bladder cancer, supporting VI-RADS implementation in routine clinical practice. The standard MRI sequences for VI-RADS scoring are anatomical imaging, including T2w images, and physiological imaging with diffusion-weighted MRI (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI). Physiological QIBs derived from analysis of DW- and DCE-MRI data and radiomic image features extracted from mpMRI images play an important role in bladder cancer. The current development of AI tools for analyzing mpMRI data and their potential impact on bladder imaging are surveyed. AI architectures are often implemented based on convolutional neural networks (CNNs), focusing on narrow/specific tasks. The application of AI can substantially impact bladder imaging clinical workflows; for example, manual tumor segmentation, which demands high time commitment and has inter-reader variability, can be replaced by an autosegmentation tool. The use of mpMRI and AI is projected to drive the field toward the personalized management of bladder cancer patients.