In this document, it is presumed that patients have no contraindications to IV contrast agents. Special Imaging Considerations CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts. Protocols most often include unenhanced images followed by IV contrast-enhanced images, including both nephrographic and excretory phases acquired at least 5 minutes after contrast injection. In some institutions in subsets of patients (ie, less than 40 years of age or lower risk), a split-bolus technique is employed. This uses an initial dose of IV contrast and then obtains a combined nephrographic-excretory phase after a second IV contrast dose is given. Thin-slice acquisition is used with some places using reconstruction methods, commonly including maximum intensity projection or 3-D volume rendering. For the purposes of this document, we make a distinction between CTU and CT abdomen and pelvis without and with IV contrast protocols not specifically tailored for the evaluation of the upper and lower urinary tracts. MR urography (MRU) is an imaging study also tailored to improve visualization of the urinary system. Unenhanced MRU relies upon heavily T2-weighted imaging (much like MRCP imaging) of the intrinsic high signal intensity from urine. Contrast-enhanced MRU includes IV contrast administration to provide additional information regarding obstruction, urothelial thickening, and focal lesions. Postcontrast-enhanced T1-weighted series should include the corticomedullary, nephrographic, and excretory phase. Thin-slice acquisition and multiplanar imaging should be obtained. For the purposes of this document, we make a distinction between MRU and MRI abdomen and pelvis without and with IV contrast protocols not specifically tailored for evaluation of the upper and lower urinary tracts. Bone Scan Whole Body There is no relevant literature to support the use of whole-body bone scan in the evaluation of NMIBC.
Pretreatment Staging of Urothelial Cancer. In this document, it is presumed that patients have no contraindications to IV contrast agents. Special Imaging Considerations CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts. Protocols most often include unenhanced images followed by IV contrast-enhanced images, including both nephrographic and excretory phases acquired at least 5 minutes after contrast injection. In some institutions in subsets of patients (ie, less than 40 years of age or lower risk), a split-bolus technique is employed. This uses an initial dose of IV contrast and then obtains a combined nephrographic-excretory phase after a second IV contrast dose is given. Thin-slice acquisition is used with some places using reconstruction methods, commonly including maximum intensity projection or 3-D volume rendering. For the purposes of this document, we make a distinction between CTU and CT abdomen and pelvis without and with IV contrast protocols not specifically tailored for the evaluation of the upper and lower urinary tracts. MR urography (MRU) is an imaging study also tailored to improve visualization of the urinary system. Unenhanced MRU relies upon heavily T2-weighted imaging (much like MRCP imaging) of the intrinsic high signal intensity from urine. Contrast-enhanced MRU includes IV contrast administration to provide additional information regarding obstruction, urothelial thickening, and focal lesions. Postcontrast-enhanced T1-weighted series should include the corticomedullary, nephrographic, and excretory phase. Thin-slice acquisition and multiplanar imaging should be obtained. For the purposes of this document, we make a distinction between MRU and MRI abdomen and pelvis without and with IV contrast protocols not specifically tailored for evaluation of the upper and lower urinary tracts. Bone Scan Whole Body There is no relevant literature to support the use of whole-body bone scan in the evaluation of NMIBC.