In a study of 91 examinations in 88 patients with suspected UTUC, MRU had a sensitivity of 72.4% to 86.2% and specificity of 97.9% to 99.5% for UTUC for 2 readers, respectively [40]. Radiography Chest All patients with MIBC require imaging of the thorax. Chest radiographs are an effective screening examination and should be performed at regular intervals. Any abnormality identified on radiography should be followed with a CT examination for improved characterization. Radiography Intravenous Urography CTU and, to a lesser extent, MRU have replaced IVU for the evaluation of the upper urinary tract. In a study of 128 patients at high risk for UTUC, in whom 46 patients were diagnosed with UTUC, excretory urography had a per- patient sensitivity of 80.4% (37 of 46) and a specificity of 81.0% (47 of 58), whereas CTU had a sensitivity of 93.5% (43 of 46) and a specificity of 94.8% (55 of 58) [64]. IVU is not recommended for detection of tumor recurrence. However, IVU could be used to assess for ureteral anastomotic patency if reflux cannot be demonstrated on a loopogram. US Pelvis (Bladder) Following cystectomy, the acoustic window is limited, and US is of little clinical use for the identification of local recurrence or nodal metastatic disease. Given the high incidence of recurrent disease (up to 46% of patients) following cystectomy for MIBC, surveillance imaging with CT or MRI is recommended [43]. US may be useful to assess the kidneys for hydronephrosis in the setting of declining renal function, regardless of whether the urinary bladder has been resected or not. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac.
Post Treatment Surveillance of Bladder Cancer. In a study of 91 examinations in 88 patients with suspected UTUC, MRU had a sensitivity of 72.4% to 86.2% and specificity of 97.9% to 99.5% for UTUC for 2 readers, respectively [40]. Radiography Chest All patients with MIBC require imaging of the thorax. Chest radiographs are an effective screening examination and should be performed at regular intervals. Any abnormality identified on radiography should be followed with a CT examination for improved characterization. Radiography Intravenous Urography CTU and, to a lesser extent, MRU have replaced IVU for the evaluation of the upper urinary tract. In a study of 128 patients at high risk for UTUC, in whom 46 patients were diagnosed with UTUC, excretory urography had a per- patient sensitivity of 80.4% (37 of 46) and a specificity of 81.0% (47 of 58), whereas CTU had a sensitivity of 93.5% (43 of 46) and a specificity of 94.8% (55 of 58) [64]. IVU is not recommended for detection of tumor recurrence. However, IVU could be used to assess for ureteral anastomotic patency if reflux cannot be demonstrated on a loopogram. US Pelvis (Bladder) Following cystectomy, the acoustic window is limited, and US is of little clinical use for the identification of local recurrence or nodal metastatic disease. Given the high incidence of recurrent disease (up to 46% of patients) following cystectomy for MIBC, surveillance imaging with CT or MRI is recommended [43]. US may be useful to assess the kidneys for hydronephrosis in the setting of declining renal function, regardless of whether the urinary bladder has been resected or not. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac.