For the purposes of this manuscript, NMIBC has been divided into 2 categories: NMIBC without symptoms or risk factors (low-risk patients) and NMIBC with symptoms or risk factors (intermediate- and high-risk patients). Local practice patterns (NCCN versus AUA/SUO) should determine whether upper-tract surveillance should be considered in patients with intermediate risk and no symptoms. Special Imaging Considerations Cystoscopic and Virtual Cystoscopic Surveillance Patients with NMIBC undergo routine surveillance cystoscopy to assess for recurrence and progression to MIBC. As cystoscopy is a relatively invasive procedure, there was previous interest in developing virtual cystoscopic or cystographic techniques using CT or MRI, particularly for problem solving and for cases in which conventional cystoscopy is difficult, such as for the evaluation of narrow-necked diverticula. CT cystography, following the instillation of air, saline, or water-soluble contrast into the urinary bladder via a Foley catheter, and MRI evaluation of the urinary bladder with virtual cystoscopy (3-D fly through) and cystography (T2-weighted turbo spin-echo imaging) are not commonly performed and do not eliminate the need for conventional cystoscopy. CTU CTU CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts. There is variability in the specific parameters, but it usually involves unenhanced images followed by intravenous (IV) contrast-enhanced images, including nephrographic and excretory phases acquired at least 5 minutes after contrast injection. Alternatively, a split-bolus technique uses an initial loading dose of IV contrast and then obtains a combined nephrographic-excretory phase after a second IV contrast dose; some sites include arterial phase. CTU should use thin-slice acquisition. Reconstruction methods commonly include maximum-intensity projection or 3-D volume rendering.
Post Treatment Surveillance of Bladder Cancer. For the purposes of this manuscript, NMIBC has been divided into 2 categories: NMIBC without symptoms or risk factors (low-risk patients) and NMIBC with symptoms or risk factors (intermediate- and high-risk patients). Local practice patterns (NCCN versus AUA/SUO) should determine whether upper-tract surveillance should be considered in patients with intermediate risk and no symptoms. Special Imaging Considerations Cystoscopic and Virtual Cystoscopic Surveillance Patients with NMIBC undergo routine surveillance cystoscopy to assess for recurrence and progression to MIBC. As cystoscopy is a relatively invasive procedure, there was previous interest in developing virtual cystoscopic or cystographic techniques using CT or MRI, particularly for problem solving and for cases in which conventional cystoscopy is difficult, such as for the evaluation of narrow-necked diverticula. CT cystography, following the instillation of air, saline, or water-soluble contrast into the urinary bladder via a Foley catheter, and MRI evaluation of the urinary bladder with virtual cystoscopy (3-D fly through) and cystography (T2-weighted turbo spin-echo imaging) are not commonly performed and do not eliminate the need for conventional cystoscopy. CTU CTU CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts. There is variability in the specific parameters, but it usually involves unenhanced images followed by intravenous (IV) contrast-enhanced images, including nephrographic and excretory phases acquired at least 5 minutes after contrast injection. Alternatively, a split-bolus technique uses an initial loading dose of IV contrast and then obtains a combined nephrographic-excretory phase after a second IV contrast dose; some sites include arterial phase. CTU should use thin-slice acquisition. Reconstruction methods commonly include maximum-intensity projection or 3-D volume rendering.