Muscle-invasive bladder cancer (MIBC) has a tendency toward urothelial multifocality and is at risk for local and distant spread, most commonly to the lymph nodes, bone, lung, liver, and peritoneum. Pretreatment staging of MIBC should include imaging of the urothelial upper tract for synchronous lesions; imaging of the chest, abdomen, and pelvis for metastases; and MRI pelvis for local staging. CT abdomen and pelvis without and with contrast (CT urogram) is recommended to assess the urothelium and abdominopelvic organs. Pelvic MRI can improve local bladder staging accuracy. Chest imaging is also recommended with chest radiograph usually being adequate. FDG-PET/CT may be appropriate to identify nodal and metastatic disease. Chest CT may be useful in high-risk patients and those with findings on chest radiograph. Nonurogram CT and MRI of the abdomen and pelvis are usually not appropriate, and neither is radiographic intravenous urography, Tc-99m whole body bone scan, nor bladder ultrasound for pretreatment staging of MIBC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Journal of the American College of Radiology : JACR. 2018 May [Epub]
Expert Panel on Urologic Imaging: , Christian B van der Pol, V Anik Sahni, Steven C Eberhardt, Aytekin Oto, Oguz Akin, Lauren F Alexander, Brian C Allen, Fergus V Coakley, Adam T Froemming, Pat F Fulgham, Keyanoosh Hosseinzadeh, Jodi K Maranchie, Rekha N Mody, Nicola Schieda, David M Schuster, Aradhana M Venkatesan, Carolyn L Wang, Mark E Lockhart
Research Author, Brigham & Women's Hospital, Boston, Massachusetts., Principal Author, Brigham & Women's Hospital, Boston, Massachusetts. Electronic address: ., Panel Chair, University of New Mexico, Albuquerque, New Mexico., Panel Vice Chair, University of Chicago, Chicago, Illinois., Memorial Sloan Kettering Cancer Center, New York, New York., Emory University Hospital, Atlanta, Georgia., Duke University Medical Center, Durham, North Carolina., Oregon Health & Science University, Portland, Oregon., Mayo Clinic, Rochester, Minnesota., Urology Clinics of North Texas, Dallas, Texas; American Urological Association., Veterans Administration, Durham, North Carolina., UPMC, Pittsburgh, Pennsylvania; American Urological Association., Cleveland Clinic, Cleveland, Ohio., Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada., University of Texas MD Anderson Cancer Center, Houston, Texas., University of Washington, Seattle Cancer Care Alliance, Seattle, Washington., Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama.