MRI Head Without IV Contrast There is no relevant literature to support the use of MRI head without IV contrast in the evaluation of MIBC. MRI Pelvis Without and With IV Contrast For local staging of bladder cancer, MRI is considered the best imaging technique because of its superior soft tissue contrast resolution compared with CT [106]. MRI is particularly useful for detecting bladder cancer invasion of the detrusor muscle, perivesical tissues, and nearby organs [5,47,48]. Klein and Pollack [49] noted that MRI has a better sensitivity and specificity than CT for local staging, with the most significant advantage being its ability to distinguish between superficial and deep invasion of the bladder detrusor muscle. For deeply infiltrating tumors (stages T3b-T4b), they concluded that MRI is the most accurate staging technique, making CT unnecessary when MRI is available. Beyersdorff et al [21] concluded that MRI is superior to CT for assessing the depth of invasion in the bladder wall, although both techniques may have difficulty differentiating between tumor and inflammation from previous transurethral biopsy. However, recent studies suggest that adding DWI to conventional pelvic MRI may aid in distinguishing treatment response and detecting residual/recurrent disease [50]. Pretreatment Staging of Urothelial Cancer approach resulted in sensitivity ranging from 61% to 94%, specificity ranging from 90% to 99%, and accuracy ranging from 83% to 96% on a per-patient basis. Razik et al [111] compared the diagnostic performance of stalk morphology on DWI to conventional MRI in predicting muscle invasion in bladder cancer, finding that absent or distorted stalk on DWI had the highest sensitivity (87.5%) and specificity (97.6%). Additionally, DWI was more accurate than T2-weighted imaging in staging both organ-confined and higher-stage tumors, with a reported sensitivity of 98.1% and a positive predictive value of 100%.
Pretreatment Staging of Urothelial Cancer. MRI Head Without IV Contrast There is no relevant literature to support the use of MRI head without IV contrast in the evaluation of MIBC. MRI Pelvis Without and With IV Contrast For local staging of bladder cancer, MRI is considered the best imaging technique because of its superior soft tissue contrast resolution compared with CT [106]. MRI is particularly useful for detecting bladder cancer invasion of the detrusor muscle, perivesical tissues, and nearby organs [5,47,48]. Klein and Pollack [49] noted that MRI has a better sensitivity and specificity than CT for local staging, with the most significant advantage being its ability to distinguish between superficial and deep invasion of the bladder detrusor muscle. For deeply infiltrating tumors (stages T3b-T4b), they concluded that MRI is the most accurate staging technique, making CT unnecessary when MRI is available. Beyersdorff et al [21] concluded that MRI is superior to CT for assessing the depth of invasion in the bladder wall, although both techniques may have difficulty differentiating between tumor and inflammation from previous transurethral biopsy. However, recent studies suggest that adding DWI to conventional pelvic MRI may aid in distinguishing treatment response and detecting residual/recurrent disease [50]. Pretreatment Staging of Urothelial Cancer approach resulted in sensitivity ranging from 61% to 94%, specificity ranging from 90% to 99%, and accuracy ranging from 83% to 96% on a per-patient basis. Razik et al [111] compared the diagnostic performance of stalk morphology on DWI to conventional MRI in predicting muscle invasion in bladder cancer, finding that absent or distorted stalk on DWI had the highest sensitivity (87.5%) and specificity (97.6%). Additionally, DWI was more accurate than T2-weighted imaging in staging both organ-confined and higher-stage tumors, with a reported sensitivity of 98.1% and a positive predictive value of 100%.