Imaging in bladder cancer. Can we do better?

Imaging studies are required for disease staging in muscle-invasive bladder cancer in order to evaluate the extent of local tumour invasion, the presence of tumour spread to lymph nodes and the presence of tumour spread to upper urinary tract and/or to other distant organs. Magnetic resonance (MRI) as has a higher accuracy compared to computed tomography CT for primary tumour staging thanks to its superior soft tissue contrast; however, CT remains the most commonly used imaging modality, due to its shorter acquisition time and lower susceptibility to variations related to patients' characteristics. As regards to primary tumour detection, virtual cystoscopy has been developed with promising results. To determine the lymph node status of patients with muscle-invasive bladder cancer FDG PET/CT has been tested: it seems to provide advantages over CT and MRI in lymph node assessment, even if more evidences are required. Finally, but perhaps more importantly, MRI is currently deemed to be able to differentiate T1 from T2 tumors. As this step is the most important and often the most time- and resources-consuming, if MRI is demonstrated to be reliable in such differentiation, the first steps of the diagnostic process of bladder cancer may be changed.