1) VI-RADS provides a five-point score to determine the risk of detrusor muscle invasion based on tumor appearances in T2WI, DWI and DCE; 2)Despite the high reproducibility verified so far, scoring is a trick process and requires supervised practicing. Along with a series of typical cases, some pitfalls and common errors are discussed; 3)As the VI-RADS only applies for urothelial lesions, it’s important to be aware of MRI appearances of other malignant neoplasms and benign conditions that may mimic urothelial cancers.

Bladder neoplasms are classified as epithelial and nonepithelial, and they can emerge from any of the bladder layers. Urothelial carcinoma account for the majority of urinary bladder cancer and differentiating muscle-invasive (MI) from non-muscle-invasive (NMI) tumors is vital to choose the appropriate treatment. It is noteworthy that transurethral resection of bladder tumor may not sample the muscularis propria, leading to understaging in 25% to 40% of MI cancers. In this setting, VI-RADS is a reproducible and feasible guide for Radiologists to use a standardized approach to imaging and reporting multiparametric MRI. This system provides a five-point score which effectively indicates the likelihood of detrusor muscle invasion. MRI scoring is based on T2WI, DWI and DCE. It is also important to evaluate the presence of synchronous urothelial lesions, lymph node enlargement and distant metastasis. Aside from an accurate scoring of urothelial lesions, Radiologists should be able to recognize imaging findings of other malignant neoplasms and non-malignant conditions, which may simulate urothelial cancers.