Imaging

Bladder Carcinoma

Preliminary Diagnosis: Bladder Carcinoma

I. What imaging technique is first-line for this diagnosis?

  • Gray scale and color Doppler sonographic evaluation of the kidneys and bladder

II. Describe the advantages and disadvantages of this technique for diagnosis of bladder carcinoma.

Advantages

  • Does not expose patients to ionizing radiation

  • Highly sensitivity for making a diagnosis of bladder carcinoma

  • Highly portable

  • Inexpensive

Disadvantages

  • Low specificity for bladder pathology

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to sonographic imaging exist.

IV. What alternative imaging techniques are available?

  • CT cystography

  • MRI with contrast of the abdomen and pelvis

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of bladder carcinoma.

CT cystography

Advantages

  • High sensitivity and specificity in diagnosing bladder pathology

  • May further help define perivesical invasion and involvement

  • Offers exquisite detail of the surrounding anatomical structures

  • May help guide treatment

  • Helps stage tumors

Disadvantages

  • Exposes patients to ionizing radiation

  • Less portable compared to US imaging

MRI with contrast of the abdomen and pelvis

Advantages

  • Highly sensitive and specific in detecting and diagnosing bladder patholog.

  • Does not expose patients to ionizing radiatio.

  • Offers exquisite detail of the surrounding soft tissues and helps determine extent of infiltratio.

  • Helps in staging tumor.

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Less adept in detailing the osseous structures

VI. What are the contraindications for the alternative imaging techniques?

CT cystography

May be contraindicated in pregnant patients

MRI with contrast of the abdomen and pelvis

  • Contraindicated in patients with non-MR-compatible hardware

  • Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30

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