Figure 3.

A 71-year-old man with post-TURBT focal thickening of the left lateral wall of the bladder, presenting interruption of the muscularis propria low-signal-intensity line, suggesting muscle infiltration on T2WI (asterisk in A), focal enhancement extending into the muscularis propria in dynamic contrast-enhanced MRI (asterisk in B) and a tiny focus of restricted diffusion in the muscularis propria (asterisk in C). The minimal bladder distention significantly impeded the evaluation of the lesion. Although most of the intravesical vegetative lesion was removed during TURBT, signs of remaining suspicious lesion persist with signs of extension to the muscularis propria, without obvious extravesical extension. We suggest that such lesions could be classified as VI-RADS 4 (muscle invasion likely). Histopathological analysis of the lesion indicated high-grade urothelial carcinoma with subepithelial and muscle invasion.