Imaging in Bladder Cancer Surgery

Up to date, imaging presents especially a supportive role in bladder cancer (BCa) diagnostic workup, even if it is essential in the staging phase. In fact, the final diagnosis always implicates cystoscopy. In case of suspected BCa, CT with and without contrast media intravenous injection should always include the study of the excretory phase, obtaining computed tomography urography (CTU). This technique has the aim to investigate the urinary tract, searching the presence of papillary tumors, which usually appears as filling defects and/or hydronephrosis. Multi-parametric MRI (mpMRI) shows an extremely powerful potential in the detection, description, and classification of BCa, even if it is not yet widely introduced in the international guidelines. The principal role of MRI is the local tumor staging, which is paramount to plan the most suitable treatment. Moreover, it can help to differentiate between NMIBC and MIBC, which is mandatory, because it changes the treatment planning. The promising performance of mpMRI of the bladder led to the designing of the Vesical Imaging Reporting and Data System (VI-RADS) score. This new scoring system has the aim to standardize the approach to imaging and reporting of mp-MRI for BCa and to define the risk of muscle invasion. The use of VI-RADS is now especially dedicated to the pre-TURBT workup and before intravesical BCG (Bacillus Calmette-Guerin) injection. Preoperative MRI and VI-RADS score give interesting and useful information in the evaluation of treatment response, indicating when BCa requires a more aggressive approach. Furthermore, in cases of high-risk NMIBC, VI-RADS score may play a useful role also for disease risk stratification and as an indicator of whether a secondary excision of the tumor is necessary. The high risk of tumor recurrence and the frequent necessity for a secondary tumor resection stimulate its application as a follow-up diagnostic tool.