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===Further evaluation of suspected tumors===
[[File:CT of bladder cancer.jpg|thumb|Nodular bladder tumor.]]
*Evaluate '''contrast enhancement''' by comparing images before and after IV contrast. Any focal hyperenhancement of the bladder wall must be considered suspicious for malignancy.<ref name="RamanFishman2014"/> 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.<ref name="RamanFishman2014"/> In lack of enhancement, consider a differential diagnosis of a hematoma, although the presence of an underlying tumor is still difficult to exclude.<ref name="RamanFishman2014"/>
*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.<ref name="RamanFishman2014"/>
:*Note any '''calcification''' of the bladder wall, indicates cystoscopy, particularly when there is bladder wall thickening.<ref name="RamanFishman2014"/>
:*Signs of local spread or '''metastasis'''. The most commons sites of metastasis of bladder cancers are lymph nodes, bones, lungs, liver and peritoneum.<ref name="ShinagareRamaiya2011">{{cite journal|last1=Shinagare|first1=Atul B.|last2=Ramaiya|first2=Nikhil H.|last3=Jagannathan|first3=Jyothi P.|last4=Fennessy|first4=Fiona M.|last5=Taplin|first5=Mary-Ellen|last6=Van den Abbeele|first6=Annick D.|title=Metastatic Pattern of Bladder Cancer: Correlation With the Characteristics of the Primary Tumor|journal=American Journal of Roentgenology|volume=196|issue=1|year=2011|pages=117–122|issn=0361-803X|doi=10.2214/AJR.10.5036}}</ref>
Moved to there
*CTs with contrast: Tumors within the kidney, ureters or bladder.
:*Signs of bladder tumor:
::*Bladder wall thickening, which may indicate a bladder tumor, especially when nodular or irregular.<ref name="RamanFishman2014"/> However, the anterior wall is frequently thickened in a normal underdistended bladder.<ref name="RamanFishman2014"/> Also, diffuse bladder wall thickening rarely represents malignancy.<ref name="RamanFishman2014"/> 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.<ref name="RamanFishman2014"/>In suspected bladder tumor, see '''[[CT of urinary bladder tumors]]'''
:*Lymph nodes. Enlarged lymph nodes may be metastases. Generalized lymphadenopathy may indicate lymphoma, and in such cases tumors in the urinary system may be lymphomas as well.<ref name="RamanFishman2014"/>
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