The main benefit of MRU over CTU includes inherent higher contrast resolution [62]. In addition, when the entire upper tract is not visualized or degraded by motion artifact, MRU sequences can be repeated without fear of added radiation risk. Inherent higher contrast resolution of MRU is particularly beneficial for small tumor detection. MRU Without IV Contrast Noncontrast MRU using a heavily T2-weighted sequence can be an alternative for assessing the renal collecting systems and ureters [63]. MRU may be performed for nodal, synchronous upper tract or bladder, and metastatic staging. The main benefit of MRU over CTU includes inherent higher contrast resolution [62]. In addition, when the entire upper tract is not visualized or degraded by motion artifact, MRU sequences can be repeated multiple times without fear of added radiation risk. Inherent higher contrast resolution of MRU is particularly beneficial for small tumor detection. Radiography Chest It is recommended that all patients with MIBC undergo pulmonary evaluation [30]. A chest radiograph is a low- morbidity screening tool that has been shown to be effective [74]. Patients with MIBC who have abnormal chest radiograph findings or are at high risk should undergo chest CT, consistent with other guidelines [31,32]. Radiography Intravenous Urography The use of CTU and MRU has largely replaced IVU for evaluating the upper urinary tract urothelium. Excretory urography has a reported sensitivity of 50% to 70% for detecting upper urinary tract lesions [37]. However, a study comparing the accuracy of CTU and excretory urography in detecting and locating upper urinary tract UC favored CTU, with per-patient sensitivity, specificity, and overall accuracy rates of 93.5%, 94.8%, and 94.2%, respectively. This contrasts with excretory urography, which had rates of 80.4%, 81.0%, and 80.8%, respectively [37].
Pretreatment Staging of Urothelial Cancer. The main benefit of MRU over CTU includes inherent higher contrast resolution [62]. In addition, when the entire upper tract is not visualized or degraded by motion artifact, MRU sequences can be repeated without fear of added radiation risk. Inherent higher contrast resolution of MRU is particularly beneficial for small tumor detection. MRU Without IV Contrast Noncontrast MRU using a heavily T2-weighted sequence can be an alternative for assessing the renal collecting systems and ureters [63]. MRU may be performed for nodal, synchronous upper tract or bladder, and metastatic staging. The main benefit of MRU over CTU includes inherent higher contrast resolution [62]. In addition, when the entire upper tract is not visualized or degraded by motion artifact, MRU sequences can be repeated multiple times without fear of added radiation risk. Inherent higher contrast resolution of MRU is particularly beneficial for small tumor detection. Radiography Chest It is recommended that all patients with MIBC undergo pulmonary evaluation [30]. A chest radiograph is a low- morbidity screening tool that has been shown to be effective [74]. Patients with MIBC who have abnormal chest radiograph findings or are at high risk should undergo chest CT, consistent with other guidelines [31,32]. Radiography Intravenous Urography The use of CTU and MRU has largely replaced IVU for evaluating the upper urinary tract urothelium. Excretory urography has a reported sensitivity of 50% to 70% for detecting upper urinary tract lesions [37]. However, a study comparing the accuracy of CTU and excretory urography in detecting and locating upper urinary tract UC favored CTU, with per-patient sensitivity, specificity, and overall accuracy rates of 93.5%, 94.8%, and 94.2%, respectively. This contrasts with excretory urography, which had rates of 80.4%, 81.0%, and 80.8%, respectively [37].