Imaging muscle-invasive and metastatic urothelial carcinoma.

Purpose Of Review: Muscle-invasive bladder cancer (MIBC) comprises approximately one-third of bladder cancers and is associated with significant morbidity and mortality. Accurate staging of bladder cancer is essential because of significantly different treatment options and the consequences of inaccurate staging. The current recommended method for staging is transurethral resection of the bladder tumor followed by contrast-enhanced computed tomography (CT). In this review, we discuss cross-sectional imaging approaches used to assess local, nodal, and distant metastases in MIBC.

Recent Findings: Determining the most accurate imaging method for staging MIBC is a contentious issue. CT with contrast is a practical approach; however, there is potential for understaging of small lymph nodes or foci of metastasis. Multiparametric MRI is emerging as the imaging modality of choice in tumor staging, with a reported accuracy of more than 90%. Locoregional lymph node metastasis can also be accurately evaluated using functional MRI and specific contrast agents with paramagnetic characteristics. PET/CT with conventional radiotracers is a common imaging modality for staging distant metastases.

Summary: Conventional imaging methods for evaluating MIBC are of limited use. However, recent advances in molecular imaging, targeted contrast agents, and functional MRI have shown promising results for the staging of bladder cancer.