CT of urinary bladder tumors
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Author:
Mikael Häggström [notes 1]
Contents
Planning
Indication for CT urography in hematuria
Most patients with macroscopic hematuria, especially when over 50 years, should undergo both cystoscopy and CT urography.[1]
Microscopic hematuria indicates further workup with cystoscopy and/or CT urography if there are significant underlying risk factors, mainly:[1]
- Male sex
- Age, especially being older than 60 years
- Smoking
- Pelvic radiation
Configuration
CT urography: Without and with IV contrast.
Evaluation
Detecting urinary bladder tumors
Look for signs of urinary bladder tumors, which mainly are:
- Wall thickening, especially when nodular or irregular.[1] However, the anterior wall is frequently thickened in a normal underdistended bladder.[1] Also, diffuse bladder wall thickening rarely represents malignancy.[1] Look both at images 40 seconds after IV contrast and with contrast-containing bladder lumen, since that contrast may both demarcate a tumor as well as obscure one by beam-hardening artifacts.[1]
- Enlarged lymph nodes, which, may be metastases. Generalized lymphadenopathy may indicate lymphoma, and in such cases tumors in the urinary system may be lymphomas as well.[1]
Further evaluation of suspected tumors
- Evaluate contrast enhancement by comparing images before and after IV contrast. Any focal hyperenhancement of the bladder wall must be considered suspicious for malignancy.[1] For transitional cell cancers, the most common form of bladder cancer, enhancement peaks at about 100 HU at approximately 60 seconds, and then decreasing slowly.[1] In lack of enhancement, consider a differential diagnosis of a hematoma, although the presence of an underlying tumor is still difficult to exclude.[1]
- Measure size
- For bladder tumors:
- Classify shape such as for example nodular or polypoid. In case of well circumscribed and smoothly marginated borders, consider bladder leiomyoma as a differential diagnosis.[1]
- Note any calcification of the bladder wall, indicates cystoscopy, particularly when there is bladder wall thickening.[1]
- Signs of local spread or metastasis. The most commons sites of metastasis of bladder cancers are lymph nodes, bones, lungs, liver and peritoneum.[2]
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 USA: Raman, Siva P.; Fishman, Elliot K. (2014). "Bladder Malignancies on CT: The Underrated Role of CT in Diagnosis ". American Journal of Roentgenology 203 (2): 347–354. doi:. ISSN 0361-803X.
- ↑ Shinagare, Atul B.; Ramaiya, Nikhil H.; Jagannathan, Jyothi P.; Fennessy, Fiona M.; Taplin, Mary-Ellen; Van den Abbeele, Annick D. (2011). "Metastatic Pattern of Bladder Cancer: Correlation With the Characteristics of the Primary Tumor ". American Journal of Roentgenology 196 (1): 117–122. doi:. ISSN 0361-803X.
