Table 2. Principles of imaging for advanced or metastatic bladder cancer.
| Purpose | Imaging strategy | |
|---|---|---|
| Staging for MIBC | • Chest imaging | |
| - CT of the chest with or without contrast (preferred) | ||
| - PA and lateral chest X-ray | ||
| • Abdomen/pelvis imaging | ||
| - CTU (CT of the abdomen and pelvis without and with contrast with excretory imaging) | ||
| - MRU for patients with poor renal function or contrast allergy (but with GFR >30 and no acute failure) | ||
| - Renal ultrasonography and CT without contrast for those who cannot receive any contrast agents | ||
| - MRI of the pelvis may be performed in addition to CTU | ||
| • FDG-PET/CT (category 2B) | ||
| - in selected patients with ≥cT2 disease | ||
| Follow-up with or without cystectomy for MIBC | • Chest imaging | |
| - Chest CT (preferred) or chest X-ray every 3–6 months for 2 years, then annually for up to 5 years | ||
| • Abdomen/pelvis imaging | ||
| - CTU or MRU every 3–6 months for 2 years, then abdomen/pelvis CT or MRI annually for up to 5 years | ||
| • FDG-PET/CT (category 2B) | ||
| - In patients with high-risk MIBC if metastasis is suspected | ||
| Follow-up for metastatic disease | • Chest and abdomen imaging | |
| - CT chest/abdomen/pelvis Chest CT every 3–6 months with any clinical change or new symptoms, which can be modified according to systemic therapy or surveillance plan | ||
| - CTU or MRU every 3–6 months as abdomen/pelvis imaging if clinically indicated and with any clinical change or new symptoms | ||
| • FDG-PET/CT (category 2B) | ||
| - If metastasis is suspected | ||
| Evaluation for suspected bone metastasis | • Patients at high risk or with symptoms or laboratory indicators of bone metastasis may be imaged with MRI, FDG-PET/CT (category 2B), or bone scan. FDG-PET/CT (category 2B) may also be considered for cases of suspected extraosseous metastases | |
| Neurologic/brain imaging | • Brain MRI without and with contrast for symptomatic or high-risk (e.g., small cell histology) patients. CT with contrast is considered only when MRI is contraindicated (e.g., non-MRI-compatible devices or foreign body) | |
MIBC = muscle invasive bladder cancer, CT = computed tomography, PA = posteroanterior, CTU = CT urography, MRU = MR urography, GFR = glomerular filtration rate, MRI = magnetic resonance imaging, FDG = fluorodeoxyglucose, PET = positron emission tomography