In another study of patients with a history of UC, CTU had a sensitivity of 77.8% (63 of 81) and specificity of 77.9% (60 of 77) for the detection of bladder cancer [39]. CTU for the evaluation of the upper urinary tract is effective in patients with symptoms, particularly in the setting of a negative cystoscopy. In a study of CTU in 121 patients at risk for urothelial recurrence after TURBT (with symptoms or positive urine cytology), 19 upper-tract recurrences were identified in 13 patients. In this study, accuracy for upper-tract recurrence was better in the nephrographic phase compared with the pyelographic phase (86.7% [260 of 300] versus 80.0% [240 of 300], P = . 028) [38]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT is generally not appropriate for patients with NMIBC. The risk of metastatic disease is extremely low, FDG is excreted by the kidneys, and activity obscures evaluation of the upper and lower urinary tract for recurrent disease. MRI Abdomen and Pelvis Although distant metastatic disease is uncommon in this patient population, cross-sectional imaging may be used to assess for metastatic disease in patients with symptoms or risk factors. There is no relevant literature regarding the use of MRI abdomen and pelvis without IV contrast in the evaluation of metastatic UC. Given the improved Post-Treatment Surveillance of Bladder Cancer soft-tissue contrast of MRI compared with CT, MRI of the abdomen and pelvis without IV contrast may be acceptable for the identification of metastatic disease; however, MRI without and with IV contrast is preferred to improve sensitivity. MRU, however, is a comprehensive examination and can be used to assess for metastatic disease and metachronous upper-tract UC (see below). There has been increasing interest in using MRI for local staging of bladder cancer in the pretreatment setting. Several meta-analyses of MRI for local staging of bladder cancer have been performed.
Post Treatment Surveillance of Bladder Cancer. In another study of patients with a history of UC, CTU had a sensitivity of 77.8% (63 of 81) and specificity of 77.9% (60 of 77) for the detection of bladder cancer [39]. CTU for the evaluation of the upper urinary tract is effective in patients with symptoms, particularly in the setting of a negative cystoscopy. In a study of CTU in 121 patients at risk for urothelial recurrence after TURBT (with symptoms or positive urine cytology), 19 upper-tract recurrences were identified in 13 patients. In this study, accuracy for upper-tract recurrence was better in the nephrographic phase compared with the pyelographic phase (86.7% [260 of 300] versus 80.0% [240 of 300], P = . 028) [38]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT is generally not appropriate for patients with NMIBC. The risk of metastatic disease is extremely low, FDG is excreted by the kidneys, and activity obscures evaluation of the upper and lower urinary tract for recurrent disease. MRI Abdomen and Pelvis Although distant metastatic disease is uncommon in this patient population, cross-sectional imaging may be used to assess for metastatic disease in patients with symptoms or risk factors. There is no relevant literature regarding the use of MRI abdomen and pelvis without IV contrast in the evaluation of metastatic UC. Given the improved Post-Treatment Surveillance of Bladder Cancer soft-tissue contrast of MRI compared with CT, MRI of the abdomen and pelvis without IV contrast may be acceptable for the identification of metastatic disease; however, MRI without and with IV contrast is preferred to improve sensitivity. MRU, however, is a comprehensive examination and can be used to assess for metastatic disease and metachronous upper-tract UC (see below). There has been increasing interest in using MRI for local staging of bladder cancer in the pretreatment setting. Several meta-analyses of MRI for local staging of bladder cancer have been performed.