Emerging Role of Multiparametric MRI in the Staging of Bladder Cancer: Insights From the BladderPath Trial

This narrative review synthesizes the current evidence on multiparametric magnetic resonance imaging (mpMRI) in bladder cancer staging, emphasizing the clinical significance of the BladderPath trial, a prospective randomized comparison of mpMRI versus conventional transurethral resection of bladder tumors (TURBT). While TURBT remains the standard diagnostic approach, emerging evidence suggests that mpMRI-based pathways may offer advantages in terms of diagnostic speed and staging accuracy. The BladderPath trial reported a median 45-day reduction in the time to definitive treatment with an imaging-first approach without compromising early oncological outcomes. However, these findings must be interpreted with caution because of the trial's limitations, including its restrictive inclusion of patients with suspected muscle-invasive disease. This review contextualizes mpMRI within the broader diagnostic landscape, evaluates its readiness for wider clinical adoption, and outlines key challenges, such as implementation variability, access disparities, and the need for long-term data for informed evidence-based practices.