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Early-detection demo · Bladder · Urothelial

VI-RADS 4 muscle-invasion suspicion in painless gross haematuria

3.2 cm sessile bladder mass at the right lateral wall · MRI VI-RADS 4 — high muscle-invasion suspicion.

Patient: Aleksandr · 64 · 40-pack-year smokerModality: MRIRisk: high · 77/100
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01

Risk profile

What OCTON knew before the scan
Risk
77
high
Tier
high
Painless gross haematuria × 3 weeks · prior occupational rubber-industry exposure · cystoscopy revealed papillary tumor.
Contributing factors
  • Tobacco use 40 pack-years+28
  • Painless gross haematuria+20
  • Occupational aromatic-amine exposure+12
  • Age 64+8
  • Male sex+6
  • Family history negative+0
Narrative

Painless gross haematuria + smoking is the textbook urothelial-cancer presentation. VI-RADS 4 raises the pre-test probability of muscle invasion — drives upfront cystectomy or trimodality therapy.

02

Scan + AI report

What MRI found · Multiparametric pelvic MRI · VI-RADS protocol
MRI · DEMO
VI-RADS 4
OCTON · scanning · live
conf 0.85
OCTON Impression · 82% confidence

3.2 cm sessile mass at the right lateral bladder wall with disrupted muscularis-propria signal on T2 + DWI · VI-RADS 4.

Findings
  • 3.2 cm sessile mass · right lateral bladder · Bladder right lateral wall32 mm
  • Disrupted T2 muscularis signal · Right wall
  • DWI restriction with low ADC at the muscle layer · Mass
  • No pelvic lymphadenopathy · Pelvis
Differential diagnosis
  • Muscle-invasive urothelial carcinoma (≥ T2)70%
  • High-grade non-muscle-invasive (T1)18%
  • Urachal carcinoma6%
  • Squamous cell carcinoma (post-schistosomiasis)6%
Recommended actions
  • ▸TURBT with detrusor sampling within 2 weeks
  • ▸Multidisciplinary uro-oncology — neoadjuvant cisplatin chemo before cystectomy if muscle-invasive
  • ▸Smoking cessation referral
  • ▸Upper-tract CT urogram to exclude UTUC
Caveats
  • VI-RADS 4 is a high but not perfect predictor — TURBT pathology is decisive.
  • Muscle-invasive disease is potentially curable with neoadjuvant chemo + cystectomy.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Cystoscopy + urine cytology
FrequencyPer AUA NMIBC schedule
Startsage 18
AUA NMIBC 2024
Monitoring
MRI VI-RADS staging
FrequencyOnce on visible tumor
Startsage 18
VI-RADS Working Group 2018
Monitoring
Surveillance cystoscopy post-treatment
FrequencyEvery 3 mo Y1-2, q6 mo Y3-5
Startsage 18
AUA NMIBC 2024
04

What changed

The early-detection win

Painless haematuria in a 40-pack-year smoker → VI-RADS 4 muscle-invasion suspicion routes the patient to neoadjuvant chemo + cystectomy — potentially curative.

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