Table 1.

Initial evaluation of suspicious bladder cancer and Recommendations

Modality	Patient condition, status and Recommendations	Reference
Cystoscopy	microscopic hematuria (in >35 years old): recommended macroscopic hematuria (all patients): recommended bladder cancer risk factors (all patients): performed microscopic hematuria (<35 years old): can be performed according to bladder cancer suspicion	[5,12]
CTU	Asymptomatic microscopic hematuria: CTU (with and without intravenous contrast agent) is applied with sufficient phases to exclude a renal tumor and an excretory phase to assess upper urinary tract.	[5,12]
MRU	Recommended for patients with allergies to intravenous contrast agents and renal failure	[5,12]
CT	Recommended before bladder tumor resection	[5]
MRI	Recommended before bladder tumor resection Recommended for patients with allergies to intravenous contrast agents and renal failure	[5,12]
US	Recommended for patients with allergies to intravenous contrast agents and renal failure	[5,17–21]
PET/CT	MIBC: staging, follow-up (patients who do not have basal imaging, in high risk patients in case of metastasis suspicion, guidance for biopsy, suspicion of bone metastasis)	[5,6]
Bone scan	MIBC ( suspicion of bone metastasis)	[5]

Note– CT= Computed Tomography, MRI= Magnetic Resonance Imaging, CTU= Computed Tomography Urography, MRU= Magnetic Resonance Urography, US= Ultrasonography, PET/CT= Positron Emission Tomography/Computed Tomography, MIBC= Muscle Invasive Bladder Cancer