Bladder cancer: can imaging change patient management?

Overview

PURPOSE OF REVIEW: Recent technical advances have an impact on the management of patients with bladder cancer. RECENT FINDINGS: Intravenous pyelography has been largely replaced with multiphasic computed tomography urography performed on multislice computed tomography scanners. The new computed tomography technique allows direct and indirect detection of urothelial cancer throughout the urothelium and also identifies other causes of hemorrhage in patients presenting with hematuria. Thin-slice and multiplanar reconstructions have improved computed tomography staging of bladder cancer. In addition, computed tomography allows evaluation for lymphatic and distant metastases in a single examination. MRI continues to have a role in evaluating the depth of tumor invasion into the bladder wall but the assessment is difficult after transurethral resection of the bladder. SUMMARY: Multislice spiral computed tomography with a multiphase computed tomography urography protocol supplementing cystoscopy is currently considered the imaging modality of choice for examining patients with microscopic and gross hematuria. Computed tomography and MRI can visualize bladder cancer and perivesical infiltration, but MRI is superior for evaluation of the depth of invasion in the bladder wall.