Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
Curr Opin Urol. 2020 May;30(3):377-386. doi: 10.1097/MOU.0000000000000743.
Accurate staging of bladder cancer is essential to guide appropriate management. In this review, we discuss the principles, applications and performance of multiparametric MRI (mpMRI) and PET-computer tomography (PET-CT) for local and distant staging of bladder cancer.
Bladder mpMRI has a high diagnostic performance in local staging of bladder cancer, superior to other imaging modalities. It can accurately differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC), as well as ≤T2 from ≥T3 stages. mpMRI can be used to assess pelvic lymph nodes, although its sensitivity is relatively low. For the assessment of the upper urinary tract, CT urography is the imaging modality of choice. magnetic resonance urography is a viable alternative to CT in selected cases. Although PET-CT is accurate for nodal and distant staging of bladder cancer, there is no clear evidence on its superior diagnostic performance compared with contrast-enhanced CT.
mpMRI is the most accurate imaging modality for local staging of bladder cancer, capable to accurately distinguish MIBC from NMIBC. Nodal and distant staging relies primarily on contrast-enhanced CT.
准确分期膀胱癌对于指导适当的管理至关重要。在这篇综述中，我们讨论了多参数 MRI（mpMRI）和正电子发射断层扫描-计算机断层扫描（PET-CT）在膀胱癌局部和远处分期中的原理、应用和性能。
膀胱癌 mpMRI 在膀胱癌的局部分期中具有较高的诊断性能，优于其他成像方式。它可以准确地区分肌层浸润性膀胱癌（MIBC）和非肌层浸润性膀胱癌（NMIBC），以及 T2 期及以下和 T3 期及以上。mpMRI 可用于评估盆腔淋巴结，但其敏感性相对较低。对于上尿路的评估，尿路 CT 造影是首选的影像学方法。在某些情况下，磁共振尿路造影是 CT 的可行替代方法。尽管 PET-CT 对膀胱癌的淋巴结和远处分期准确，但与增强 CT 相比，其诊断性能是否优越尚无明确证据。
mpMRI 是膀胱癌局部分期最准确的影像学方法，能够准确区分 MIBC 和 NMIBC。淋巴结和远处分期主要依赖于增强 CT。
