Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Review Review Urol Int 2010;85:373–380 DOI: 10.1159/000321279 Imaging in Bladder Cancer: Present Role and Future Perspectives accurate preoperative staging is critical to appropriately triage patient management. Staging with direct visualiza- tion through cystoscopy is most suited for non-muscle- invasive tumors, whereas non-invasive imaging is helpful in the detection of local extension of the tumor, lymph node involvement and distant metastases for invasive tu- mors. Because urothelial cancer is a panurothelial dis- ease, extensive diagnostic workup is required for evalua- tion of the primary tumor and identification of possible extra tumors in addition to the primary tumor site [4]. Therefore, imaging of the bladder alone is not sufficient. Intravenous urography (IVU) supplemented by tomogra- phy has been largely replaced by newer imaging mo- dalities such as computed tomography urography (CTU) and magnetic resonance imaging (MRI). New aspects have emerged from recent positron emission tomography (PET) studies, which have implications for the evaluation of lymph nodes in assessing tumor extent and for follow- up after radical cystectomy [5, 6]. Ultrasonography Sonography is the mandatory exam in the clinical evaluation of hematuria for detection of bladder tumors because it is easy to perform and safe for the patient, but its success depends on size and location of the neoplasm [7]. Bladder tumors !0.5 cm in size and tumors localized Key Words Imaging ? Bladder neoplasms ? Tumor staging Abstract Advances in imaging have an increasingly significant role in the diagnosis, staging and restaging of patients with bladder cancer. This paper reviews the current use of imaging in bladder neoplasms, comparing the different radiologic in- vestigations, and discusses the potential applications of nov- el imaging techniques in the management of patients with bladder cancer. Copyright © 2010 S. Karger AG, Basel Introduction Bladder cancer is the 4th most common malignancy in men and the 9th most common malignancy in women [1]. Transitional cell carcinoma accounts for over 90% of cases and is by far the most common epithelial tumor of the bladder. A reliable screening test is not available. It is thought that patients at high risk for bladder cancer prob- ably benefit from screening, although there are no con- clusive data proving that screening reduces mortality from bladder cancer [2]. Treatment and prognosis of bladder cancer are based on the depth of primary tumor invasion and the presence of metastases [3]. Therefore, Received: August 30, 2010 Accepted: September 4, 2010 Published online: October 21, 2010 Francesco Pinto, MD Istituto di Urologia, Dipartimento di Scienze Chirurgiche Policlinico A. Gemelli, Università Cattolica del Sacro Cuore L. go Francesco Vito 1, IT–00168 Rome (Italy) Tel. +39 06 3015 5290, Fax +39 06 3015 5975, E-Mail francesco.pinto @ libero.it © 2010 S. Karger AG, Basel 0042–1138/10/0854–0373$26.00/0 Accessible online at: www.karger.com/uin Angelo Totaro  a , Francesco Pinto  a Antonio Brescia  c , Marco Racioppi  a Emanuele Cappa  a Daniele D’Agostino  a , Andrea Volpe  a Emilio Sacco  a , Giuseppe Palermo  a AnnaLia Valentini  b PierFrancesco Bassi  a   Departments of a  Urology and b  Radiology, Catholic University, Rome, and c  Department of Urology, Istituto Oncologico Europeo, Milan, Italy