Imaging of Bladder Cancer
fig. 1. A coronal maximum intensity projection image obtained from excretory
phase
CT urography (CTU) shows bilateral urinary collecting systems and
bladder are
opacified with contrast.
Fig. 2. 85-year-old woman who has history of bladder cancer, status postcystectomy.
(A)Coronal MIP image from the excretory phase shows narrowing of a left upper pole
infundibulum (arrow). (B) Axial source image obtainedduring the excretory phase
shows corresponding nodular thickening to the urothelium at this location(arrow),
which subsequently was proven to represent transitional cell carcinoma on surgical
pathology
Fig. 3. 85-year-old woman who has transitional cell carcinoma (TCC) of the left renal
collecting system. (A) Axialexcretory phase CTU image demonstrates a discrete nodular
filling defect (arrow) within the left renal pelvis. (B)A sagittal oblique MIP reconstruction
as seen on A, image of the left kidney demonstrates the tumor (T) within the renal pelvis
as well as focal urothelial thickening with irregular narrowing of the upper pole calyx
(arrow).
Fig. 4. 58-year-old man who has TCC of the right renal pelvis. (A) Axial contrastenhanced CTU image duringparenchymal phase demonstrates enhancing tumor
(arrows) in the right renal pelvis. (B) On axial excretoryphase CTU images, this lesion
persists as a filling defect (T). (C) MIP reconstruction image of the right kidney
in the coronal oblique plane provides an IVP-like image and demonstrates the overall
extent of the tumor(T). The upper pole calyx is dilated and does not demonstrate
contrast excretion, caused by tumor obstruction
Fig. 5. 82-year-old man’s status after cystectomy and ileal neobladder
reconstruction for bladder cancer, presenting with negative urine cytology. (A) Axial
parenchymal phase CTU image shows left ureteral narrowing with mild wall
thickening at the level where the ureter crosses the abdominal midline (arrow) right
ureteral stump.(B) A coronal thin MIP reconstructed from the excretory phase CTU
images confirms the segmental narrowing of distal left ureter as shown on A
(arrows). This finding was stable on multiple subsequent surveillance CTUs and
considered most likely to be a postoperative change.
Fig. 6. 77-year-old man who has TCC of the bladder. (A) Parenchymal phase CTU
image demonstrates a 5-mmenhancing papillary lesion (arrow) arising from the anterior
bladder wall. (B) Excretory phase images do not readily demonstrate the lesion, as the
non-dependent portion of the urine in the bladder is not opacified with contrast. (C).
Repeat excretory phase image in the prone position demonstrates the pedunculated
tumor as a discrete filling defect (arrow).
Fig. 7. 72-year-old man who has bladder cancer. (A) Early parenchymal phase CTU
image demonstrates a bladder mass (arrow) with avid enhancement. (B) Excretory
phase CTU image demonstrates the lesion as a papillary, nodular filling defect (arrow) in
the opacified bladder adjacent to the left ureterovesicular junction (UVJ). (C) Coronal
thin MIP image from excretory phase CTU images demonstrates the mass as a filling
defect (arrow) adjacent to the left UVJ.
Fig. 8. 67-year-old man who has metastatic bladder cancer. Contrast-enhanced CT
image demonstrates a large enhancing mass in the anterior bladder wall
(long arrow). The mass has grown through the bladder wall with anterior perivesical soft
tissue (short arrow) indicative of perivesical invasion.
Fig. 9. 65-year-old man who has remote cystectomy for bladder cancer. Axial contrastenhanced CT image demonstrates a lytic metastatic lesion in the left acetabulum
with large soft tissue component and invasion into the adjacent internal obturator muscle
(arrows).
Fig. 10. 85-year-old woman who has metastatic bladder cancer.
(A) Contrast-enhanced CT image
of the abdomen shows an
enhancing soft tissue nodule
(arrow) anterior to the left
psoas muscle consistent with
metastatic disease.
(B) Contrast-enhanced CT image of the
abdomen shows metastatic
retroperitoneal adenopathy (*).
Fig. 11. 64-year-old woman who has bladder cancer. (A) Sagittal T2 weighted MR image
(TR 5167 milliseconds, TE107 milliseconds, field of view 20 cm, matrix 384 256)
demonstrates a large bladder mass with invasion of the urethra, anterior uterine
myometrium and vagina (arrows). (B) Axial T2 weighted MR image (TR 4400 illiseconds,
TE 108 milliseconds, field of view 20 cm, matrix 256 192) demonstrates the large bladder
mass with gross extravesical invasion, uterine invasion, and obstruction to the right ureter
(arrow). (C) Sagittal contrast enhanced T1 weighted MR image (TR 190 milliseconds, TE
4.2 milliseconds, field of view 28 cm, matrix 256 128) demonstrates avid enhancement
within the large tumor (arrow(
Fig. 12. 58-year-old man who has bladder cancer. (A) Axial T2 weighted image (TR
5000 milliseconds, TE 112 milliseconds, field of view 20 cm, matrix 448 256)
demonstrates multifocal papillary lesions (arrows) projecting into the bladder lumen. The
bladder lesions demonstrate slightly higher T2 signal compared with the bladder wall.
Note that an intact, low-signal intensity muscle layer is present at the bases of the
tumors. The patient was confirmed to have stage T1 bladder cancer on pathology.
(B) On axial T1 weighted image (TR 550 milliseconds,TE 11 milliseconds, field of view
34 cm, matrix 256 128), the bladder tumors (arrows) demonstrate intermediate signal
intensity similar to that of the bladder wall.
Fig. 13. 67-year-old man who has metastatic bladder cancer. (A) Axial T2 weighted image
(TR 4567 milliseconds , TE 98 milliseconds, field of view 18 cm, matrix 256 224)
demonstrates a large infiltrating tumor (vertical arrow)in the anterior bladder wall.
The normal low signal of anterior bladder wall muscle is replaced by the intermediate
tumor signal throughout its entire thickness, indicative of deep muscle invasion. The outer
border is irregular and shaggy, with an ill-defined soft tissue nodule (horizontal arrow) in
the prevesical fat, indicating perivesical invasion. (B) On axial T1 weighted image (TR 600
milliseconds, TE 14 milliseconds, field of view 32cm, matrix 256 192), the bladder tumor
(vertical arrow) demonstrates intermediate signal intensity similar to that of the bladder
wall. Perivesical invasion also is seen on this T1 weighted image (horizontal arrow).
(C) Sagittal contrast-enhanced T1 weighted image with fat suppression (TR 3.9
milliseconds, TE 1.9 milliseconds,field of view 24cm, matrix 256 192) demonstrates early
and avid enhancement in the anterior bladder mass (oblique arrow).
Also note the enhancing soft tissue in prevesical fat indicating perivesical tumor invasion
(horizontal arrow).
Fig. 14. 75-year-old man who has bladder cancer. Longitudinal ultrasound image of the
bladder demonstrates a large intraluminal bladder mass. Biopsy of the mass revealed
invasive high-grade urothelial carcinoma with sarcomatoid features, myxoid
background, and extensive necrosis.
Fig. 15. 47-year-old man who has bladder cancer. Transverse ultrasound image of the
bladder demonstrates bilateral intraluminal bladder masses (arrows).
Feeding blood vessels in the masses are documented by color Doppler. Radical
cystectomy was performed, and urothelial carcinoma was found with perivesical
invasion.
Fig. 16. 65-year-old man who has multiple myeloma presenting with hematuria. Oblique
ultrasound image of the bladder demonstrated a well-defined echogenic mass in the
dependent portion of the bladder. Doppler ultrasound did not detect any vascularity
within this mass. This mass resolved in a fewdays with bladder irrigation, consistent with
a blood clot.
Fig. 17. 68-year-old man who has TCC
arising from bladder diverticulum with
perivesical invasion.
(A) Excretory phase CTU image
demonstrates a right bladder
diverticulum (arrow).
(B) More superior portion of the bladder
diverticulum demonstrates a filling defect
indicative of a soft tissue mass (arrow).
This was confirmed to be TCC with
perivesical invasion on surgical
pathology.
Mild asymmetric thickening of the right
bladder wall also was noted, proven to
represent post biopsy reactive changes
on pathology
Fig. 18. 20-year-old woman who has Hodgkin’s and non-Hodgkin’s lymphoma status after
bone marrow transplant, presenting with gross hematuria. Hemorrhagic cystitis was
diagnosed on cystoscopy. (A) Contrast-enhanced CT image of the pelvis demonstrated
circumferentially thickened bladder wall with vague intraluminal areas of increased
attenuation (arrows).
(B) Ultrasound image obtained 4 days after the CT demonstrated thickened bladder wall
and intraluminal echogenic areas (arrows) consistent with blood clots, corresponding to
the areas of increased attenuation on CT.
Fig. 19. 64-year-old man’s status after resection of stage T1 high-grade bladder TCC,
presenting with chills, arthralgias, and myalgias after commencing second course of
intravesical BCG treatment. (A) Contrast-enhanced CT image of the pelvis demonstrated
focal nodular thickening with enhancement of the left anterior bladder wall (arrow), which
was new compared with prior examinations. After treatment with antituberculosis
medications, this completely resolved. Subsequent biopsy showed only inflammatory
cells.
Fig. 20. 49-year-old man who has urachal adenocarcinoma. Axial contrast-enhanced CT
demonstrated a 2 cm focal area of soft tissue thickening (arrow) at the bladder dome
with extension into the adjacent perivesical fat. Patient underwent a partial cystectomy,
excision of urachus, and umbilicus. Pathology revealed an urachal adenocarcinoma.
Fig. 21. 47-year-old woman who has lymphoma. Contrast-enhanced CT image of the
abdomen demonstrated diffuse asymmetric left bladder wall thickening (arrow). Note the
presence of air in nondependent portion of the bladder from recent instrumentation.
Fig. 22. 57-year-old woman with high-grade sarcomatoid carcinoma of the bladder.
Contrast-enhanced CT image of the pelvis (A) and ultrasound image of the bladder
(B) demonstrate a poorly defined large mass (arrows) involving the left lateral wall of the
bladder with left hydronephrosis (not shown), and invading the vagina and lower uterine
segment.
Fig. 23. 74-year-old man who has invasive neuroendocrine small cell carcinoma of
the bladder. Contrastenhanced CT of the pelvis demonstrates an enhancing
2 1 cmsoft tissue mass (arrow) in the left posterolateral bladder wall.
Fig. 24. 64-year-old man’s status after recent transurethral resection of noninvasive
bladder tumor. Contrast-enhanced CT image of the pelvis demonstrated posterior
bladder wall thickening with superficial enhancement along the bladder mucosa
(arrows), and the presence of perivesical inflammatory change.
Fig. 25. 52-year-old man who has worsening fever, chills, and night sweats after
intravesical BCG therapy for bladder cancer.
(A) Contrast-enhanced CT image of the abdomen demonstrated a large hypoattenuating
mass (*) in the midportion of the left kidney. After several weeks of antituberculosis
therapy, the lesion significantly decreased in size (not shown), and the patient’s
constitutional symptoms resolved
Fig. 26. 67-year-old man’s status after intravesical BCG treatment of bladder cancer,
presenting with elevated prostate-specific antigen and palpable prostate nodule on digital
weighted endorectal MR image of the prostate (TR rectal examination. Axial T2
5017 milliseconds, TE 100 milliseconds, field of view14 cm, matrix 256 192)
demonstrates a large nodule (arrows) at the base of the posterior peripheral zone with
capsular bulging, corresponding to the nodule palpated on digital examination.
Subsequent ultrasound-guided prostate biopsy confirmed granulomatous prostatitis.
The
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