FDG-PET/MRI Skull Base to Mid-Thigh A potential novel approach to bladder cancer imaging is FDG-PET/MRI, which combines the strengths of both modalities: superior contrast resolution and multiparametric assessment with MRI and metabolic assessment with PET. A pilot study with 22 FDG-PET/MRI examinations [42] found that FDG-PET/MRI had a higher accuracy than MRI alone for detecting bladder tumors (86% versus 77%), metastatic pelvic lymph nodes (95% versus 76%), and nonnodal pelvic malignancies (100% versus 91%). FDG-PET/MRI changed suspicion for bladder tumors in 36% of cases (50% increased, 50% decreased), for pelvic lymph nodes in 52% (36% increased, 64% decreased), and for nonnodal pelvis in 9% of cases (100% increased). Another recent study using FDG-PET/MRI [43] demonstrated a similar performance of FDG-PET/MRI (sensitivity 80%, specificity 56%) compared with CT (sensitivity 91%, specificity 43%) in detecting primary bladder tumors. However, evaluation of nodal status was limited, because of the lack of patients with true pathologic lymph nodes. Civelek et al [44] determined the clinical Pretreatment Staging of Urothelial Cancer benefit of FDG-PET/MRI for surveillance and restaging of patients with locally advanced metastatic MIBC compared with conventional imaging methods. FDG-PET/MRI identified 82 metastatic malignant lesions involving lymph nodes, liver, lung, soft tissue, adrenal glands, prostate, and bone with a resultant advantage of 36% for lesion visibility in comparison with CT. They concluded that FDG-PET/MRI can detect metastatic lesions that would not be identified on conventional CT, and this can allow for better treatment planning and improve disease monitoring during therapy. MRI Abdomen and Pelvis Without and With IV Contrast Although there is no relevant literature to support the use of MRI abdomen and pelvis without and with IV contrast (separate from MRU) in the evaluation of MIBC, it may be useful in some clinical situations.
Pretreatment Staging of Urothelial Cancer. FDG-PET/MRI Skull Base to Mid-Thigh A potential novel approach to bladder cancer imaging is FDG-PET/MRI, which combines the strengths of both modalities: superior contrast resolution and multiparametric assessment with MRI and metabolic assessment with PET. A pilot study with 22 FDG-PET/MRI examinations [42] found that FDG-PET/MRI had a higher accuracy than MRI alone for detecting bladder tumors (86% versus 77%), metastatic pelvic lymph nodes (95% versus 76%), and nonnodal pelvic malignancies (100% versus 91%). FDG-PET/MRI changed suspicion for bladder tumors in 36% of cases (50% increased, 50% decreased), for pelvic lymph nodes in 52% (36% increased, 64% decreased), and for nonnodal pelvis in 9% of cases (100% increased). Another recent study using FDG-PET/MRI [43] demonstrated a similar performance of FDG-PET/MRI (sensitivity 80%, specificity 56%) compared with CT (sensitivity 91%, specificity 43%) in detecting primary bladder tumors. However, evaluation of nodal status was limited, because of the lack of patients with true pathologic lymph nodes. Civelek et al [44] determined the clinical Pretreatment Staging of Urothelial Cancer benefit of FDG-PET/MRI for surveillance and restaging of patients with locally advanced metastatic MIBC compared with conventional imaging methods. FDG-PET/MRI identified 82 metastatic malignant lesions involving lymph nodes, liver, lung, soft tissue, adrenal glands, prostate, and bone with a resultant advantage of 36% for lesion visibility in comparison with CT. They concluded that FDG-PET/MRI can detect metastatic lesions that would not be identified on conventional CT, and this can allow for better treatment planning and improve disease monitoring during therapy. MRI Abdomen and Pelvis Without and With IV Contrast Although there is no relevant literature to support the use of MRI abdomen and pelvis without and with IV contrast (separate from MRU) in the evaluation of MIBC, it may be useful in some clinical situations.