Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.
Categorias
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VI-RADS 1, muscle invasion highly unlikely
Muscle invasion highly unlikely. All sequences are category 1: on T2WI an uninterrupted low-signal line indicates an intact muscularis propria; on DWI the muscle layer shows continuous intermediate signal (lesion under 1 cm); on DCE there is no early enhancement of the muscularis propria.
CondutaBelow the validated VI-RADS >=3 muscle-invasion cutoff: low-probability lesion managed as non-muscle-invasive disease (e.g. transurethral resection / TURBT) rather than treated as muscle-invasive; multiparametric MRI reduces the need for upfront re-resection.
RiscoMuscle invasion highly unlikely; in validation studies, scores of 1-2 correspond to a low probability of muscle-invasive bladder cancer, well below the >=3 threshold (pooled sensitivity ~0.87-0.92 / specificity ~0.82-0.86 for the >=3 cutoff).
Muscle invasion unlikely. The low-signal muscularis line remains uninterrupted; typically an exophytic tumor with a stalk and/or a thickened high-signal inner layer on T2WI, with corresponding category-2 DWI/DCE (continuous intermediate-signal muscle on DWI for lesions over 1 cm; early enhancement of the inner layer but not the muscle on DCE).
CondutaBelow the >=3 cutoff: treated as non-muscle-invasive disease. For a small T1 tumor with a clear stalk and no muscularis-propria involvement the goal is a complete (radical) TURBT, generally without mandatory re-resection.
RiscoMuscle invasion unlikely; scores 1-2 carry a low probability of muscle-invasive cancer and fall below the >=3 muscle-invasion threshold in validation studies.
Equivocal for muscle invasion. Category-2 features are absent but there is no clear interruption of the low-signal muscularis propria (e.g. exophytic tumor lacking a stalk, or a sessile/broad-based tumor without a clearly thickened inner layer). When T2WI is equivocal, DWI (first) then DCE drive the assessment.
CondutaEquivocal zone at the validated >=3 cutoff: warrants careful surgical planning — a deeper-invading T1 tumor (T1b/c) makes a mandatory re-TUR appropriate, and clinicians should weigh treating as potentially muscle-invasive.
RiscoEquivocal probability of muscle invasion. VI-RADS 3 is the validated 'watershed' cutoff: using score >=3 to predict muscle invasion gives pooled sensitivity ~0.87-0.92 and specificity ~0.82-0.86 (about 90% accuracy in prospective cohorts).
Muscle invasion likely. At least one sequence is category 4: on T2WI the low-signal muscularis line is interrupted, suggesting tumor extension into the muscularis propria; DWI shows high-signal tumor (low ADC) extending focally into the muscle; DCE shows early-enhancing tumor extending focally into the muscularis propria.
CondutaAt/above the muscle-invasion cutoff: high suspicion of muscle-invasive bladder cancer; supports treating as muscle-invasive disease and proceeding toward definitive staging/management (e.g. radical cystectomy pathway) rather than relying on TURBT alone.
RiscoMuscle invasion likely; in validation studies a score >=4 is highly specific for muscle invasion (pooled specificity ~0.94-0.96, sensitivity ~0.78), i.e. high positive predictive value when present.
VI-RADS 5, invasion of or beyond muscle very likely
Invasion of muscle and beyond the bladder very likely. Intermediate-signal tumor extends into the extravesical fat on T2WI; on DWI/DCE the high-signal or early-enhancing tumor extends through the entire bladder wall into the perivesical fat.
CondutaVery high suspicion of muscle-invasive (and extravesical) disease: managed along the muscle-invasive/advanced pathway with definitive staging and treatment (e.g. radical cystectomy +/- neoadjuvant chemotherapy as clinically indicated), not TURBT alone.
RiscoInvasion of muscle and beyond the bladder very likely; highest VI-RADS probability of muscle-invasive disease, well above the >=3 cutoff and within the high-specificity >=4 range.