The choice of appropriate treatment modality for bladder carcinomas depends on accurate preoperative assessment of the stage of the neoplasm (1). Both CT and MRI complemented by reconstructions can provide the needed accurate informations (2).This 52-year old white male presented with a history of gross hematuria, which intensified during the past 3 months. He had prior episodes of gross hematuria, 3 and 5 years ago, which were attributed to benign prostatic hypertrophy and treated first by TURP and later clinically.The laboratory data at this admission were RBC 4.1 M/CUMM, WBC 9400 /CUMM Hct 36.2%, Hb 12.4 g/dL, BUn 32 mg/dL, Creatinine 2.3 mg/dL, Albumin 3.2 gm/dL, ALK Ptas 12.7 U/L, AST 7U/L, ALT 22 U/L Total Protein 7.2 gm/dL Urine analysis of a voided specimen showed gross hematuria, but no blood clots, > 500 RBC/HpF, 40 -50 WBC/HpF, 20-30 bacteria / Hpf, spec gravity 1028; urine culture was reported as negative.Patient was moderately diaphoretic, BP 148/92, PR 84/min, lungs were clear to auscultation, on CXR there was cephalization of flow and basilar congestion, no infiltrates nor nodules were appreciated. The abdomen was negative. There was tenderness to percussion of the left back and flank.Four phase enhanced computed tomograms through abdomen and pelvis, complemented by coronal , sagital as well as volume reconstructions were performed.A 28-second delayed arterial phase CT demonstrates an enhancing tumor along the left lateral bladder wall extending through the muscularis into the perivesical fat. After a skip zone, hypervascularity is noted both along the anterior and posterior bladder wall reflecting submucosal tumor propagation. Some hypervascular stranding is noted extending from the anterior bladder wall into the space of Retzius and there is some nodular enhancing tumor anterior in the space of Retzius. One and one half to 2.1 cm enhancing nodes are noted in the left external iliac node chain ( Figure-1).CTs at a slightly lower scan level demonstrate the large intravesical component of the neoplasm, but also show a circumferential stain indicating