AJR 2003; 180:1045-1054
© American Roentgen Ray Society
Imaging in Oncology from the University of Texas M. D. Anderson
Cancer Center |
Imaging in the Diagnosis, Staging, and Follow-Up of Cancer of the Urinary Bladder
Vikas Kundra1 and
Paul M. Silverman
1 Both authors: Division of Diagnostic Imaging, The University of Texas M. D.
Anderson Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030.
Received March 14, 2002;
accepted after revision August 20, 2002.
Address correspondence to V. Kundra.
Introduction
We describe the epidemiology, histology, and imaging features of cancer of
the urinary bladder. Included is a review of the staging system used for this
malignancy. In addition, imaging findings are presented that show the spectrum
of radiographic findings of primary bladder carcinoma and various stages of
the disease, as well as treatment and surveillance.
Epidemiology
Cancer of the urinary bladder is predominantly a disease of older men. This
disease represents 6% of all malignancies in men, making it the fourth most
common tumor. In women, bladder carcinoma represents 2% of malignancies,
making it the seventh most common tumor
[1]. The incidence increases
with age (median age, 69–70 years). Smoking, living in urban areas, and
working in the dye, rubber, or leather industries increases the risk
[2]. In 2001, 39,200 new cases
were predicted in men and 15,100 in women from the United States. In
comparison, 8300 men and 4100 women were estimated to have succumbed to the
disease [1].
The malignancy is found twice as often in whites as in African Americans,
but the latter tend to have a later stage at diagnosis and a poorer prognosis
at all stages. In whites, the overall 5-year survival rate is 82% and 95% for
localized disease, but this rate falls to 50% for regional disease and 6% when
distant metastases are found. In comparison, the rates are 64%, 87%, 41%, and
0%, respectively, for African Americans. However, survival rates have been
increasing since the mid 1970s
[1].
Histology
The bladder is lined by a transitional cell epithelium that is three to
seven cell layers thick. Basal cells are covered by intermediate cells, and
these are capped by large, flat umbrellalike cells. Accordingly, transitional
cell carcinoma accounts for 95% of all bladder cancers
[3]. Other cell types include
squamous cell cancer, mixed transitional cell carcinoma, adenocarcinoma, and
undifferentiated tumors. Rare histologies include lymphoma, carcinosarcoma,
sarcomas, pheochromocytoma, and metastasis
[3].
The patterns of growth are broadly categorized as papillary or
infiltrative. For transitional cell carcinoma, the pattern of growth tends to
correlate with grade, which ranges from well-differentiated, grade 1, to
poorly differentiated, grade 3
[4].
Staging
Most frequently, cancer of the urinary bladder initially presents as
painless hematuria. Urine cytology may be performed; however, diagnosis
usually requires cystoscopy and biopsy. Bimanual examination is used for
staging, particularly, to determine whether adjacent organs are involved.
Although the Jewett-Marshall-Strong staging system
[5] is still used, the TNM
staging system [6] is favored
(Table 1 and
Fig. 1). For both, the depth of
invasion into the bladder and the involvement of adjacent and distant sites
are central elements.
To understand the staging systems, one must first be aware of bladder
anatomy. The bladder wall consists of four layers: mucosa or epithelium,
lamina propria or subepithelial connective tissue, muscle layer, and serosa or
the peritoneal covering found at the dome
[7]. A special case is cancer
in a diverticulum, in which lesions tend to be of a higher grade and escape
the bladder wall earlier because of the lack of a muscle layer. Thus, tumors
at this location tend to have a greater potential for metastasis and a
correspondingly poorer prognosis. The incidence of a neoplasm in a bladder
diverticulum is between 0.8% and 13.5%
[8,
9].
For superficial disease, stages Ta and T1, Campbell's Urology
[3] recommends no further
staging workup after cystoscopy and biopsy. For muscle invasive disease, stage
T2 and beyond, chest radiography, excretory urography, abdominal and pelvic
CT, bone scan, and liver function tests are recommended. Suspected metastasis
is confirmed by fine-needle biopsy
[3].
Imaging Local Disease
Radiologists may encounter cancer of the urinary bladder as a mass found on
routine imaging, staging, or follow-up after therapy. In the first instance,
an incidentally noted mass in the bladder has a broad differential diagnosis,
including benign (papilloma, hamartoma, leiomyoma) or malignant neoplasm,
hematoma, calculus, fungus ball, cystitis cystica, foreign body, and
endometriosis. Imaging characteristics such as enhancement and mobility are
helpful for characterization. For staging, cystoscopy and biopsy are used for
stages Ta–T3a disease, confined to the bladder. Cross-sectional imaging
is useful at stage T3b or later stages, after the tumor has escaped beyond the
bladder wall.
Exretory Urography
Because transitional cell carcinoma is a multifocal disease, excretory
urography may identify synchronous lesions. A primary tumor may appear as a
small-capacity, thick-walled bladder or as a focal mass (Figs.
2 and
3). It may also appear as a
filling defect or as a stricture along the course of the ureters. If severe,
obstruction may result in hydroureteronephrosis and a delayed nephrogram.
Retrograde pyelograms may also assist in this search
(Fig. 4). However, neither of
the two tests will identify spread outside the bladder. With the advent of CT
excretory urography [10], both
the urothelium and adjoining structures may be evaluated. However, this
examination is still in the process of being evaluated, as are MR urography
and virtual endoscopy [11,
12].
View larger version (147K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2. —Excretory urogram obtained in 77-year-old man with hematuria
shows that low-capacity bladder has circumferential wall thickening and
irregularity (arrows), consistent with infiltrating transitional cell
carcinoma.
|
|
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3. —Postvoid excretory urogram obtained in 66-year-old man with
hematuria shows irregular mass in bladder outlined by contrast material
(white arrows). Presence of retained contrast material in left ureter
(arrowheads) implies that mass obstructs ureteral orifice. Note
sutures (black arrow) from prior colon anastomosis.
|
|
View larger version (139K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4. —77-year-old woman with hematuria. Retrograde ureterogram
shows that transitional cell carcinoma presents as segmental stricture
(arrow) of ureter, resulting in mild hydronephrosis (white
arrowheads). Mild hydroureter (black arrowhead) is seen inferior
to stricture.
|
|
Sonography
Sonography is not routinely used for staging cancer of the urinary bladder.
If the tumor is found incidentally, it often appears as a polypoid or
plaquelike, hypoechoic lesion that may project into the bladder
[4]. Calcifications or fibrosis
produce an increase in echogenicity. Blood flow can be shown in tumors on
Doppler sonography (Fig. 5A,
5B).
View larger version (183K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5A. —48-year-old man with hematuria. Sonogram obtained in sagittal
plane reveals heterogeneous, hypoechoic mass (arrows) at
antidependent aspect of bladder. Anechoic material within bladder represents
urine (arrowhead).
|
|
CT
CT is the primary imaging modality for cancer of the urinary bladder.
Optimally, rapid scanning is performed in the nephrographic phase before
excreted IV contrast material reaches the bladder. Thus, the enhancing tumor
can be visualized against a background of low-attenuation urine within the
bladder (Fig. 6A). On delayed
scanning, the lesion appears as a mural nodule against a background of
high-attenuation contrast material within the bladder
(Fig. 6B). The mass may appear
plaquelike (Fig. 6A,
6B) or papillary
(Fig. 7). Calcifications may
also be noted (Fig. 8). Moon
et al. [13] have noted that 5%
of transitional cell carcinomas contain calcifications. Calcifications are
usually in a nodular or arched configuration on the surface, whereas 50% of
adenocarcinomas contain fine intratumoral calcifications. Mucinous
adenocarcinomas such as urachal carcinomas can have either pattern. As the
tumor grows, circumferential wall thickening may also be seen
(Fig. 9). In addition, the
mass may invade the ureteral orifice, resulting in hydroureteronephrosis
(Fig. 10). With more advanced
disease, bilateral hydronephrosis may be noted (Fig.
11A,
11B).
View larger version (164K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 9. —61-year-old woman with hematuria. CT scan shows cancer of
urinary bladder presenting as circumferential wall thickening and irregularity
(arrows) with relative sparing of posterior wall. Enhancing lesion
causes bilateral hydroureters (arrowheads).
|
|
View larger version (169K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 10. —CT scan of 93-year-old woman shows that dilated right ureter
is obstructed by tumor. Note circumferentially enhancing, irregular bladder
wall (white arrowhead). More focal mass at right ureteral orifice
(black arrowhead) causes hydroureter (arrow).
|
|
View larger version (170K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 11A. —CT of 76-year-old woman with urosepsis shows cancer of
urinary bladder causing bilateral hydronephrosis. CT scan shows that bladder
wall thickening and enhancement (black arrowhead) are more prominent
on left. Nondependent intravesicle air (white arrowhead) raises
question of emphysematous cystitis or recent instrumentation. Arrows show
bladder cancer causing obstruction and thereby dilatation of both ureters.
|
|
View larger version (137K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 11B. —CT of 76-year-old woman with urosepsis shows cancer of
urinary bladder causing bilateral hydronephrosis. CT scan obtained more
superiorly than A reveals bilateral hydronephrosis
(arrows).
|
|
As with all imaging modalities, the depth of penetration into the bladder
wall is difficult to discern. Stage T3b disease that escapes the serosa often
manifests as soft-tissue-attenuation stranding in the low-attenuation
perivesical fat (Fig. 12). The
tumor is classified as T4 disease if it invades adjacent organs or structures
such as the pelvic or abdominal walls
(Fig. 13). Invasion may
present as tissue within the organ enhancing like cancer of the urinary
bladder and as enlargement of the invaded organ.
View larger version (172K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 13. —61-year-old man with hematuria. CT scan shows cancer of
urinary bladder presenting as enhancing focal wall thickening. In addition,
extravesicle invasion of cancer (white arrow) and invasion of cancer
into left pelvic sidewall (black arrow) are present. Air (white
arrowhead) within bladder is associated with instrumentation as evidenced
by Foley catheter (black arrowhead).
|
|
Confounders for CT include biopsy and inflammation, which can mimic a
cancer. Radiation therapy results in fibrosis and can result in
circumferential wall thickening, which can also be due to obstruction such as
that caused by benign prostatic hyperplasia (Fig.
14A,
14B) or stricture of the
urethra. Chemotherapy with systemic agents such as cyclophosphamide and
ifosfamide or intravesical agents such as Bacillus
Calmette-Guérin or formalin can also cause circumferential bladder
wall thickening [14].
Radiation therapy can additionally result in stranding of pelvic fat, making
it difficult to discern perivesical invasion. If a delay in scanning occurs
after IV contrast injection, a ureteral jet can mimic bladder cancer as well
(Fig. 15A,
15B). CT limited to the axial
plane is not ideal for visualizing the dome of the bladder or the base. New
multidetector CT scanners with thin-slice selection and multiplanar
reformatting should aid in the evaluation of these areas (Fig.
16A,
16B,
16C). The accuracy of CT for
staging has been variously reported as 55–92%
[3,
15,
16,
17,
18,
19,
20,
21].
View larger version (166K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 14A. —77-year-old man with prostate cancer. CT scan shows that in
addition to cancer of urinary bladder, circumferential wall thickening
(arrowheads) can be associated with chemotherapy or radiation
therapy, neurogenic bladder, or obstruction caused, for example, by benign
prostatic hyperplasia.
|
|
View larger version (163K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 15A. —CT of 60-year-old man with hepatocellular carcinoma shows
ureteral jet mimicking cancer of urinary bladder. CT scan shows apparently
enhancing lesion (arrow) along left bladder wall. Indentation along
posterior aspect of bladder is due to prostate (arrowhead).
|
|
View larger version (142K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 15B. —CT of 60-year-old man with hepatocellular carcinoma shows
ureteral jet mimicking cancer of urinary bladder. Lesion is not seen
(arrow) on delayed CT scan. Indentation along posterior aspect of
bladder is due to prostate (arrowhead). Indentation may also resemble
cancer of urinary bladder.
|
|
View larger version (86K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 16C. —65-year-old man with microhematuria. Reformatted CT can
further define bladder tumor. CT scan obtained in sagittal plane better shows
involvement of base (arrow) of bladder than do A and B.
Arrowhead identifies left seminal vesicle.
|
|
MR Imaging
The multiplanar imaging capabilities and high tissue contrast of MR imaging
should theoretically result in increased accuracy for staging compared with
CT. However, similar results have been found, with accuracy ranging from 72%
to 96% [15,
16,
17,
18,
22,
23,
24,
25]. Staging is improved with
gadolinium enhancement [22,
24,
25,
26,
27,
28]. Nonetheless, there does
not as yet appear to be a consensus in the literature that MR imaging is
superior to
CT.
,
View larger version (109K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 18C. —65-year-old man with hematuria. T1-weighted (C) and
gadolinium-enhanced (D) MR images with fat saturation show infiltration
of tumor into perivesical fat (long white arrow) and seminal vesicles
(arrowheads and short white arrows). Thickening and
enhancement of posterior aspect of bladder is noted (short black
arrows). This tumor grew around seminal vesicles to invade them from
periphery (arrowheads) and grew posteriorly to infiltrate them
medially (short white arrows). Curved arrow shows high signal in
bladder lumen.
|
|
View larger version (113K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 18D. —65-year-old man with hematuria. T1-weighted (C) and
gadolinium-enhanced (D) MR images with fat saturation show infiltration
of tumor into perivesical fat (long white arrow) and seminal vesicles
(arrowheads and short white arrows). Thickening and
enhancement of posterior aspect of bladder is noted (short black
arrows). This tumor grew around seminal vesicles to invade them from
periphery (arrowheads) and grew posteriorly to infiltrate them
medially (short white arrows). Curved arrow shows high signal in
bladder lumen.
|
|
As with CT, MR imaging cannot depict the depth of bladder wall invasion,
but it is used for stage T3b disease and beyond (i.e., once the tumor escapes
the bladder wall) [29]. On
T2-weighted imaging, tumor has an intermediate signal, slightly higher than
that of the bladder wall. Fat has a low signal but may have a high signal if
faster sequences such as fast spin-echo are used. Urine has a high signal
(Fig. 17A).
On T1-weighted sequences, the tumor has an intermediate signal and
contrasts with the high signal in fat. In addition, urine in the bladder has a
lower signal than the tumor (Fig.
17B). T1 sequences are helpful for evaluating spread into the
perivesical fat. Cancer of the urinary bladder enhances after gadolinium
injection (Fig. 17C). Peak
enhancement is earlier than that of the bladder wall, which may be helpful if
dynamic imaging is performed. Gadolinium contrast enhancement can obscure
discrimination of tumor invading into the adjacent high-signal fat
(Fig. 18A). Fat-saturated
images can be helpful in this regard (Fig.
18B). Enhancement with or without fat saturation can show invasion
into adjacent organs (Figs.
18A and
18B). Coronal
(Fig. 18E) and sagittal planes
can also be useful in identifying perivesical invasion, particularly at the
dome and at the base of the bladder. Synchronous or metachronous lesions in
the ureters may also be detected on MR imaging
(Fig. 19). Confounders on MR
imaging are for the most part the same as those for CT, including recent
biopsy, inflammation, radiation therapy, and chemotherapy-induced changes that
mimic tumor.
View larger version (121K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 18A. —65-year-old man with hematuria. T1-weighted (A) and
gadolinium-enhanced (B) MR images show that tumor (short black
arrows) invades perivesical fat (long black arrow) and seminal
vesicles (arrowheads and short white arrows). Curved arrow
shows high signal within bladder lumen. B also shows enhancement of
tumor (short black arrows) and invasion into adjacent structures
(long black arrow, arrowheads, and short white arrows).
|
|
View larger version (124K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 18B. —65-year-old man with hematuria. T1-weighted (A) and
gadolinium-enhanced (B) MR images show that tumor (short black
arrows) invades perivesical fat (long black arrow) and seminal
vesicles (arrowheads and short white arrows). Curved arrow
shows high signal within bladder lumen. B also shows enhancement of
tumor (short black arrows) and invasion into adjacent structures
(long black arrow, arrowheads, and short white arrows).
|
|
View larger version (137K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 18E. —65-year-old man with hematuria. Multiplanar imaging can
assist in visualization of tumor. On this coronal T1-weighted MR image, tumor
presents as low-signal thickening at base of bladder (arrowheads). On
right, bladder wall is irregular and infiltration of fat is seen. Low-signal
wall is disrupted on right compared with left, implying invasion into
perivesical fat (straight arrows). High signal in bladder (curved
arrow) is from prior injection of contrast material.
|
|
View larger version (85K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 19. —77-year-old woman with hematuria. Contrast enhanced
T1–weighted MR image shows enhancing soft-tissue-attenuation material
along medial aspect of right ureter (arrow). Transitional cell
carcinoma was seen simultaneously with transitional cell carcinoma in
bladder.
|
|
Imaging of Metastasis
Cancer of the urinary bladder may metastasize via the lymphatic system or
the vasculature. In either case, cross-sectional imaging modalities are vital
for diagnosis.
Lymphatic Metastasis
Cancer of the urinary bladder first spreads to the perivesical, obturator,
internal and external iliac, and presacral lymph nodes. The perivesical nodes
are less often involved [30].
Eventually, common iliac and paraaortic lymph node metastases are noted.
Involvement of juxtaregional sites is uncommon without spread to regional
sites, implying that, if found, regional sites should be scrutinized.
Evaluation of juxtaregional areas becomes even more important if the patient
has had a lymph node dissection.
Both CT and MR imaging are dependent on lymph node enlargement to detect
metastasis (Fig. 20A,
20B,
20C). Those lymph nodes
greater than 1 cm in size in the short axis are considered suspicious
[31]. If needed, involvement
can be confirmed by percutaneous needle biopsy. Confounders include benign
hyperplasia, infection, or inflammation resulting in lymph node enlargement.
Potentially, MR imaging with ultrasmall paramagnetic iron oxide non-colloid
particles will help differentiate lymph nodes containing metastasis
[32,
33].
View larger version (159K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 20A. —CT and MR imaging show cancer of urinary bladder with lymph
node metastases. CT scan of 76-year-old man shows enlarged obturator
(black arrow) and internal iliac (white arrow) lymph
nodes.
|
|
View larger version (143K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 20B. —CT and MR imaging show cancer of urinary bladder with lymph
node metastases. CT scan (same patient as in A) shows lymph node
(black arrow). Tumor invasion into fat (white arrow) is also
seen adjacent to anterior bladder wall mass.
|
|
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 20C. —CT and MR imaging show cancer of urinary bladder with lymph
node metastases. T1-weighted MR image of 75-year-old man shows enhancing lymph
node (arrow) on left at level of bifurcation of common iliac
artery.
|
|
Hematogenous Metastasis
Cancer of the urinary bladder, particularly transitional cell carcinoma,
spreads through the blood stream as well. Favored sites for metastasis include
the liver, lungs, skeleton, and adrenal glands
[34].
Treatment
The primary surgical procedure for cancer of the urinary bladder is
resection via cystoscopy, which is adequate for early stages. Cystoscopic
surgery is not adequate for more advanced diseases; therefore, chemotherapy,
radiation therapy, and surgery are used. The first two can result in findings
such as a thickened bladder wall. In addition, radiation therapy can result in
fat stranding that can mimic the original tumor. Types of surgery may include
partial cystectomy, total cystectomy, or cystoprostatectomy, often with lymph
node dissection. Two basic types of urinary diversions are performed.
Cutaneous urinary diversions are either incontinent (Bricker ileal loop) or
continent (Kock ileal pouch or Indiana pouch). The other type is a neobladder
consisting of primarily two procedures: Kock pouch or Studer pouch. Because of
fewer complications, a Studer pouch is often favored. This procedure is often
performed with a prostatectomy and a lymph node dissection. Thus, aortocaval
and inguinal lymph nodes may be the first to signify recurrence in these
patients. With the urinary diversion procedures, hydroureter and mild
pelvocaliectasis are often seen early and may either resolve or remain stable.
However, severe pelvocaliectasis implies obstruction from a stricture, stone,
or recurrence [35].
Surveillance
Because cancer of the urinary bladder is a multifocal process with both
synchronous and metachronous lesions, recurrence is common; thus, surveillance
cystoscopy is performed after resection of an early-stage tumor. In evaluating
more advanced tumors, Ellis et al.
[36] found that after bladder
resection, recurrence occurred at the cystectomy site in 37% of patients, and
adenopathy was found in 67% of patients. Although recurrence (Figs.
21 and
22) usually occurs within the
first 1.5 years, it can be seen 3 or more years later, both locally and at
distant sites. Both CT and MR imaging are mainstays in evaluating
recurrence.
View larger version (130K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 21. —68-year-old man with pelvic pain. CT scan shows recurrence of
cancer of urinary bladder presenting as heterogeneous soft-tissue-attenuation
lesion invading right pelvic side wall (white arrows). Presacral
soft-tissue thickening (black arrow) is caused by tumor and prior
radiation therapy. Clips (black arrowhead) in pelvis are from prior
cystectomy. White arrowhead identifies midpelvic scar.
|
|
View larger version (148K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 22. —67-year-old man with pelvic pain. Gadolinium-enhanced
T1-weighted axial MR image with fat saturation shows that recurrence of cancer
of urinary bladder originating in right pelvic side wall (arrows) has
grown through sciatic notch (arrowhead).
|
|
Summary
Primarily a disease of older men, cancer of the urinary bladder is believed
to occur in the setting of an altered urothelium that has a propensity for
both synchronous and metachronous tumors. Diagnosis of early-stage disease is
performed primarily via cystoscopy. However, after the tumor escapes the
bladder wall, radiologic methods such as CT and MR imaging are critical in
evaluating local invasion and distant metastasis.
Acknowledgments
We thank Brenda J. Sommerville for her technical support and for her
professional illustration of staging for cancer of the urinary bladder seen in
Figure 1.
References
- Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer Statistics.
CA Cancer J Clin
2001;51:15
–36[Abstract/Free Full Text]
- American Cancer Society. Cancer facts and
figures, Atlanta, GA: American Cancer Society,
1999: 15–16
- Messing EM, Catalona W. Campbell's urology,
7th ed. Philadelphia: Saunders, 1998:2327
–2410
- MacVicar D, Husband JE. Radiology in the staging of bladder cancer.
Br J Hosp Med
1994;51:454
–458[Medline]
- Jewett HJ, Strong GH. Infiltrating carcinoma of the bladder:
relation of depth of penetration of the bladder wall to incidence of local
extension and metastases. J Urol
1946;55:366
–372
- Sobin LH, Wittekend CH, eds. TNM classification of
malignant tumours, 6th ed. New York: Wiley-Liss,
2002: 199–202
- Barentsz J, Lemmens JA, Ruijs SA, et al. Carcinoma of the urinary
bladder: MR imaging using a double surface coil. AJR
1988;151:107
–212[Abstract/Free Full Text]
- Lowe FC, Goldman SM, Oesterling JE. Computerized tomography in the
evaluation of transitional cell carcinoma in bladder diverticula.
Urology
1989;34:390
–395[Medline]
- Das S, Amar AO. Vesical diverticulum associated with bladder
carcinoma: therapeutic implications J Urol
1986;136:1013
–1014[Medline]
- Chow LC, Sommer FG. Multidetector CT urography with abdominal
compression and three-dimensional reconstruction. AJR
2001;177:849
–855[Free Full Text]
- Nolte-Ernsting CC, Adam GB, Gunther RW. MR urography: examination
techniques and clinical applications. Eur Radiol
2001;11:355
–372[Medline]
- Fielding JR, Hoyte LX, Okon SA, et al. Tumor detection by virtual
cystoscopy with color mapping of bladder wall thickness. J
Urol 2002;167:559
–562[Medline]
- Moon WK, Kim SH, Cho JM, Han M. Calcified bladder tumors: CT
features. Acta Radiol
1992;33:440
–443[Medline]
- Ramchandani P, Pollack HM. Radiology of drug-related genitourinary
disease. Semin Roentgenol
1995;30:77
–87[Medline]
- Amendola MA, Glazer GM, Grossman HB, Aisen AM, Francis I. Staging
of bladder carcinoma: MRI-CT surgical correlation. AJR
1986;146:1179
–1183[Abstract/Free Full Text]
- Bryan PJ, Butler HE, LiPuma JP, Resnick MI, Kursh ED. CT and MR
imaging in staging bladder neoplasms. J Comput Assist
Tomogr 1987;11:96
–101[Medline]
- Husband JE, Oliff JF, Williams MP, et al. Bladder cancer: staging
with CT and MR imaging. Radiology
1989;173:435
–440[Abstract/Free Full Text]
- Tanimoto A, Yusa Y, Imai Y, et al. Bladder tumor staging:
comparison of conventional and gadolinium-enhanced dynamic MR imaging and CT.
Radiology
1992;185:741
–747[Abstract/Free Full Text]
- Caterino M, Giunta S, Finocchi V, et al. Primary cancer of the
urinary bladder: CT evaluation of the T parameter with different techniques.
Abdom Imaging
2001;26:433
–438[Medline]
- Vock P, Haertel M, Fuchs WA, et al. Computed tomography in staging
carcinoma of the urinary bladder. Br J Urol
1982;54:158
–163[Medline]
- Sager EM, Talle K, Fossa S, et al. The role of CT in demonstrating
perivesical tumor growth in the preoperative staging of carcinoma of the
urinary bladder. Radiology
1983;146:443
–446[Abstract/Free Full Text]
- Barentsz JO, Witjes JA, Ruijis JH. What is new in bladder cancer
imaging. Urol Clin North Am
1997;24:583
–602[Medline]
- Buy JN, Moss AA, Guinet C, et al. MR staging of bladder carcinoma:
correlation with pathologic findings. Radiology
1988;169:695
–700[Abstract/Free Full Text]
- Neuerburg JM, Bohndorf K, Sohn M, Teufl F, Guenther R, Daus H.
Urinary bladder neoplasms: evaluation with contrast-enhanced MR imaging.
Radiology
1989;172:739
–743[Abstract/Free Full Text]
- Doringer E, Joos H, Forstner R, Schmoller H. Magnetic resonance
imaging of urinary bladder carcinoma: tumor staging and gadolinium
contrast-enhanced imaging. Eur Radiol
1992;2:124
–129
- Kim B, Semelka RC, Ascher SM, et al. Bladder tumor staging:
comparison of contrast enhanced CT, T1- and T2-weighted MR imaging, dynamic
gadolinium-enhanced imaging, and late gadolinium-enhanced imaging.
Radiology
1994;193:239
–245[Abstract/Free Full Text]
- Dobson MJ, Carrington BM, Collins CD, et al. The assessment of
irradiated bladder carcinoma using dynamic contrast-enhanced MR imaging.
Clin Radiol
2001;56:94
–98[Medline]
- Barentz JO, Jager GJ, Engelbrecht M, et al. Fast dynamic
gadolinium-enhanced MR imaging of urinary gladder and prostate cancer.
J Magn Reson Imaging
1999;10:295
–304[Medline]
- MacVicar AD. Bladder cancer staging. BJU
Int 2000;86:111
–122
- Wishnow KI, Johnson DE, Ro JY, et al. Incidence, extent and
location of unsuspected pelvic lymph node metastases in patients undergoing
radical cystectomy for bladder cancer. J Urol
1987;137:408
–410[Medline]
- Vinnicombe SJ, Norman AR, Nicolson V, Husband JE. Normal pelvic
lymph nodes: evaluation by CT scanning after bipedal lymphangiography.
Radiology
1995;194:349
–355
Top
Introduction
Epidemiology
