What is the role of imaging studies in the diagnosis of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Imaging studies of the upper urinary tract are an integral part of the hematuria workup. CT scans of the abdomen and pelvis with contrast are recommended. Two commonly used alternative techniques are magnetic resonance imaging (MRI) and renal ultrasonography. A retrograde pyelogram can also be done to assess the upper tracts. [64]

Intravenous pyelography (IVP) was the traditional standard for upper tract urothelium imaging; however, it is a poor modality for evaluating the renal parenchyma. Few centers in the United States perform IVP today, although the test is still included in the National Comprehensive Cancer Network (NCCN) guidelines as an acceptable modality for imaging the upper tract collecting system. [1]  European Association of Urology (EAU) guidelines recommend CT urography as more informative than IVP for upper urinary tract tumors. [69]

The bladder urothelium is not well visualized with routine imaging studies, including CT and MRI. Small tumors are easily missed on images produced by these modalities. Irregular areas on images, which may appear to represent mucosal abnormalities, are often artifacts of incomplete bladder filling; delayed images following contrast administration can better visualize actual filling defects. CIS is not visible on images from any current radiographic study.

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