Imaging and Staging of Transitional Cell Carcinoma: Part 2, Upper Urinary Tract

Abstract

The hallmark of TCC is multiplicity and recurrence. Nearly 2-4% of patients with bladder cancer develop upper tract TCC, but 40% of patients with upper tract TCC develop bladder cancer. Diagnosis of upper tract TCC is heavily dependent on imaging. Understanding the appearances of upper tract TCC on the different imaging techniques used is important in the accurate interpretation of imaging studies. Newer techniques such as CT urography are now increasingly used instead of conventional excretory urography in the surveillance of the upper tract in patients with bladder cancer.

Renal imaging at 7 Tesla: preliminary results

“…T1w GRE images provided excellent corticomedullary differentiation. This may be particularly helpful for the specification of renal tumours, as renal cell carcinomas (RCC) arise from the proximal renal tubular epithelium while renal transitional cell carcinoma (TCC) originates [24]. Furthermore, T1w imaging with fast gradient echo-based sequences allowed for a robust depiction of the renal vessels without the need for intravenous gadolinium administration.…”

CT urography: principles and indications

“…CTU enables detection of very small tumours (around 5 mm), and those that present only as urothelial wall thickening. Moreover, it is possible to evaluate periureteric spread, differentiate organ confined (stage T1 and T2) from locally invasive (stage T3 and T4) disease, and asses nodal or distant metastases 4,10 . This information pertinent to patient management and outcome are not obtainable by IVU.…”

“…This information pertinent to patient management and outcome are not obtainable by IVU. In addition, CTU has a high negative predictive value (0.98) for bladder lesions which occur in 40% of patients with upper urinary tract tumours, possibly obviating the need for further invasive diagnostic procedures when no suspicious bladder lesions in patients with upper urinary tract cancer are detected [9][10][11] .…”

Management of Non–Muscle-Invasive (Superficial) Bladder Cancer

“…In the last 10 years, computed tomographic (CT) IVU has mostly replaced conventional IVU and is the most commonly used modality to identify any possible upper or lower tract lesions, ie, tumors arising from the kidney down to the bladder, as urothe- 15 Magnetic resonance imaging (MRI) is often reserved for specific problem-solving such as characterization of lesions detected by other modalities of investigations. It is usually indicated to stage infiltrating bladder tumors and is not sensitive in differentiating submucosal invasion from muscle invasion (T1 and T2 lesions).…”