Imaging bladder cancer

To review recent developments in imaging for bladder cancer (BCa) diagnosis and staging.

Recent technical advances in multidetector computed tomography (CT) and, especially, CT urography make CT the preferred imaging modality for diagnosis and staging of BCa. CT urography combined with cystoscopy is emerging as the diagnostic imaging pathway of choice for investigating haematuria. CT provides information about local, lymph node and distant spread in a single examination.

Imaging for BCa should only be performed when it makes a difference to patient management. CT is the preferred imaging modality for diagnosing and staging urothelial cancer. Magnetic resonance (MR) imaging is superior for evaluation of the depth of tumour invasion into the bladder wall, but this knowledge may not ultimately affect treatment as feasibility for radical cystectomy depends on staging by a combination of clinical, histopathological and imaging findings. Radical cystectomy may include resection of adjacent organs and regional lymph nodes. The current purpose of CT or MR imaging is to detect T3b disease or higher and, especially, locoregional lymph node metastases. In the future, MR imaging with ultrasmall superparamagnetic iron oxide contrast agents may detect lymph nodes containing metastatic tumour, which may change treatment from surgery to chemotherapy with or without radiotherapy.