What is the role of imaging studies in the preoperative workup for radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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  • An appropriate evaluation of hematuria includes radiographic (CT scanning, ultrasonography, retrograde pyelography, intravenous pyelography [IVP]) or direct imaging (cystoscopy, ureteroscopy) of the entire urinary tract. A standard hematuria evaluation includes (1) CT scanning of the abdomen and pelvis, with and without intravenous contrast, often termed CT urography and (2) flexible cystoscopy. If a patient cannot receive intravenous contrast, the evaluation commonly consists of renal ultrasonography, cystoscopy, and retrograde ureteropyelography.

  • CT scanning and ultrasonography can reveal filling defects or masses in the urinary tract; however, they are frequently unable to demonstrate small urothelial tumors.

  • A bone scan is indicated if the patient has symptomatic bone pain, elevated calcium levels, or elevated alkaline phosphatase levels.

  • MRI is used in some centers for evaluation of both local and metastatic disease; however, its staging accuracy is unknown. Therefore, the use of MRI is currently under investigation.

  • Ferumoxtran-10–enhanced MRI and 11C-choline positron emission tomography/CT are under investigation as potential modalities for improving preoperative nodal staging. [6, 7]

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