Back to Menu
💧

VI-RADS Calculator

Bladder mpMRI — likelihood of detrusor (muscle) invasion. Pick the finding on each sequence; the score follows the dominant sequence (DWI first, DCE if DWI is suboptimal).

VI-RADS applies to treatment-naïve bladder cancer before TURBT.

T2WI — structural (SC)

first-pass guide; muscularis propria integrity
T2WI—

DWI / ADC (DW)

dominant sequence when image quality is optimal
DWI—
DWI image quality:
(if suboptimal, DCE becomes dominant)

DCE (CE)

dominant sequence when DWI is suboptimal
DCE—
—
VI-RADS
Select a category on the dominant sequence (DWI, or DCE if DWI suboptimal).
Copy to report
—
Category definitions & scoring rules

Overall VI-RADS (probability of muscle invasion)

1 highly unlikely · 2 unlikely · 3 equivocal · 4 likely · 5 invasion of/beyond muscle very likely. The dominant sequences are DWI (first) and DCE (second, especially if DWI is suboptimal); T2WI is the first-pass guide, most useful for categories 1–3. In discordance, use clinical judgment.

T2W structure DCE early enhancement DWI high b-value ADC map VI-RADS 1 Muscularis (low T2 line) intact. Tumor < 1 cm, exophytic, on a stalk; inner layer may be thin or thickened. VI-RADS 2 Muscularis intact. Tumor > 1 cm with a stalk and/or a thickened inner layer (high T2, low DWI, early enhancing on DCE). VI-RADS 3 No category 2 features: no stalk, no thickened inner layer, but no clear disruption of the muscularis line. VI-RADS 4 Muscularis line interrupted: intermediate T2 tumor, high DWI, early enhancement extending focally into the muscle. VI-RADS 5 Tumor through the full wall into perivesical fat. Key (grey level on each sequence) Tumor Stalk Inner layer Muscularis Tumor Stalk Inner layer Muscularis Tumor Stalk Inner layer Muscularis Tumor Stalk Inner layer Muscularis
Schematic: VI-RADS 1–5 on each sequence. Rows are categories, columns are T2W, early DCE, high b-value DWI and the ADC map, drawn as fixed greyscale the way each sequence actually looks (bright urine on T2W and ADC, dark lumen on DWI and early DCE). What separates 1–2 from 3 is the stalk and the thickened inner layer: on T2W the inner layer is high signal, on DWI the stalk and inner layer are low signal inside a bright tumor, on DCE the inner layer enhances early, and on ADC the stalk is bright against a dark tumor. 4 and 5 are the tumor signal crossing the muscularis line. Original illustration of the criteria in Panebianco et al. (see Reference below); not reproduced from the published figure.

Published combination (Panebianco et al., Eur Urol 2018, Table 2)

  1. VI-RADS 1: SC, CE, and DW all category 1.
  2. VI-RADS 2: SC, CE, and DW all category 2; or CE and DW category 2 with SC category 3.
  3. VI-RADS 3: SC, CE, and DW all category 3; or SC category 3 with one of CE/DW category 3 and the remaining category 2.
  4. VI-RADS 4: at least DW and/or CE category 4 (T2 3–4); or SC 3 plus DW and/or CE category 4; or SC 5 plus DW and/or CE category 4.
  5. VI-RADS 5: SC plus DW and/or CE category 5 (remaining 4–5).

This tool reports the dominant-sequence category as the overall score and shows all three sub-scores so you can apply the table above and your judgment in discordant cases.

Reference

Panebianco V, et al. Multiparametric MRI for bladder cancer: Vesical Imaging-Reporting And Data System (VI-RADS). Eur Urol 2018;74:294–306.

Dartmouth Geisel School of Medicine, Department of RadiologyDartmouth Health
© 2026 Matthew Maeder, MD. Original design and implementation, licensed under CC BY-NC 4.0 — share and adapt with attribution; no commercial use.
Educational tool — not a substitute for clinical judgment. No patient-identifiable information.