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Diagnostics  2013 

Current Staging Procedures in Urinary Bladder Cancer

DOI: 10.3390/diagnostics3030315

Keywords: urinary bladder cancer, MRI, PET/CT, FDG, choline, actetate

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Currently computed tomography (CT) represents the most widely used standard imaging modality in muscle-invasive urinary bladder cancer. Visualization of local tumor or depth of invasion as well as lymph node staging, however, is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of superparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor or lymph node involvement and therefore might play a role in routine staging of urinary bladder cancer in the future. Likewise, positron emission tomography (PET) with the currently utilized tracers 18F-FDG, 11C-choline and 11C-acetate is investigated in bladder cancer patients—mostly in combination with diagnostic CT. Although promising results could be obtained for these PET/CT examinations in smaller series, their true value cannot be determined at present.


[1]  Burger, M.; Catto, J.W.; Dalbagni, G.; Grossman, H.B.; Herr, H.; Karakiewicz, P.; Kassouf, W.; Kiemeney, L.A.; La Vecchia, C.; Shariat, S.; et al. Epidemiology and risk factors of urothelial bladder cancer. Eur. Urol. 2013, 63, 234–241, doi:10.1016/j.eururo.2012.07.033.
[2]  Stenzl, A.; Witjes, J.A.; Cowan, N.C.; De Santis, M.; Kuczyk, M.; Lebret, T.; Merseburger, A.S.; Ribal, M.J.; Sherif, A. Guidelines on Bladder Cancer Muscle-Invasive and Metastatic. Available online: (accessed on 17 May 2013).
[3]  Shariat, S.F.; Ehdaie, B.; Rink, M.; Cha, E.K.; Svatek, R.S.; Chromecki, T.F.; Fajkovic, H.; Novara, G.; David, S.G.; Daneshmand, S.; et al. Clinical nodal staging scores for bladder cancer: A proposal for preoperative risk assessment. Eur. Urol. 2012, 61, 237–242, doi:10.1016/j.eururo.2011.10.011.
[4]  Grossman, H.B.; Natale, R.B.; Tangen, C.M.; Speights, V.O.; Vogelzang, N.J.; Trump, D.L.; deVere White, R.W.; Sarosdy, M.F.; Wood, D.P., Jr.; Raghavan, D.; et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N. Engl. J. Med. 2003, 349, 859–866, doi:10.1056/NEJMoa022148.
[5]  Vale, C.; Advanced-Bladder-Cancer-Meta-Analysis-Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: A systematic review and meta-analysis. Lancet 2003, 361, 1927–1934.
[6]  Saksena, M.A.; Dahl, D.M.; Harisinghani, M.G. New imaging modalities in bladder cancer. World J. Urol. 2006, 24, 473–480.
[7]  Tekes, A.; Kamel, I.; Imam, K.; Szarf, G.; Schoenberg, M.; Nasir, K.; Thompson, R.; Bluemke, D. Dynamic MRI of bladder cancer: Evaluation of staging accuracy. Am. J. Roentgenol. 2005, 184, 121–127, doi:10.2214/ajr.184.1.01840121.
[8]  Liedberg, F.; Bendahl, P.O.; Davidsson, T.; Gudjonsson, S.; Holmer, M.; Mansson, W.; Wallengren, N.O. Preoperative staging of locally advanced bladder cancer before radical cystectomy using 3 tesla magnetic resonance imaging with a standardized protocol. Scand. J. Urol. 2013, 47, 108–112, doi:10.3109/00365599.2012.721394.
[9]  Kobayashi, S.; Koga, F.; Yoshida, S.; Masuda, H.; Ishii, C.; Tanaka, H.; Komai, Y.; Yokoyama, M.; Saito, K.; Fujii, Y.; et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in bladder cancer: Potential utility of apparent diffusion coefficient values as a biomarker to predict clinical aggressiveness. Eur. Radiol. 2011, 21, 2178–2186, doi:10.1007/s00330-011-2174-7.
[10]  Daggulli, M.; Onur, M.R.; Firdolas, F.; Onur, R.; Kocakoc, E.; Orhan, I. Role of diffusion MRI and apparent diffusion coefficient measurement in the diagnosis, staging and pathological classification of bladder tumors. Urol. Int. 2011, 87, 346–352, doi:10.1159/000330925.
[11]  Daneshmand, S.; Ahmadi, H.; Huynh, L.N.; Dobos, N. Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: Results from a prospective study. Urology 2012, 80, 1313–1318, doi:10.1016/j.urology.2012.07.056.
[12]  Saokar, A.; Islam, T.; Jantsch, M.; Saksena, M.A.; Hahn, P.F.; Harisinghani, M.G. Detection of lymph nodes in pelvic malignancies with computed tomography and magnetic resonance imaging. Clin. Imaging 2010, 34, 361–366, doi:10.1016/j.clinimag.2009.07.004.
[13]  Beer, A.J.; Eiber, M.; Souvatzoglou, M.; Holzapfel, K.; Ganter, C.; Weirich, G.; Maurer, T.; Kubler, H.; Wester, H.J.; Gaa, J.; et al. Restricted water diffusibility as measured by diffusion-weighted MR imaging and choline uptake in 11C-choline PET/CT are correlated in pelvic lymph nodes in patients with prostate cancer. Mol. Imaging Biol. 2011, 13, 352–361.
[14]  Yoshida, S.; Koga, F.; Kobayashi, S.; Ishii, C.; Tanaka, H.; Komai, Y.; Saito, K.; Masuda, H.; Fujii, Y.; Kawakami, S.; et al. Role of diffusion-weighted magnetic resonance imaging in predicting sensitivity to chemoradiotherapy in muscle-invasive bladder cancer. Int. J. Radiat. Oncol. Biol. Phys. 2012, 83, e21–e27, doi:10.1016/j.ijrobp.2011.11.065.
[15]  Tuncbilek, N.; Kaplan, M.; Altaner, S.; Atakan, I.H.; Sut, N.; Inci, O.; Demir, M.K. Value of dynamic contrast-enhanced mri and correlation with tumor angiogenesis in bladder cancer. Am. J. Roentgenol. 2009, 192, 949–955, doi:10.2214/AJR.08.1332.
[16]  Deserno, W.M.; Harisinghani, M.G.; Taupitz, M.; Jager, G.J.; Witjes, J.A.; Mulders, P.F.; Hulsbergen van de Kaa, C.A.; Kaufmann, D.; Barentsz, J.O. Urinary bladder cancer: Preoperative nodal staging with ferumoxtran-10-enhanced MR imaging. Radiology 2004, 233, 449–456, doi:10.1148/radiol.2332031111.
[17]  Froehlich, J.M.; Triantafyllou, M.; Fleischmann, A.; Vermathen, P.; Thalmann, G.N.; Thoeny, H.C. Does quantification of USPIO uptake-related signal loss allow differentiation of benign and malignant normal-sized pelvic lymph nodes? Contrast Media Mol. Imaging 2012, 7, 346–355, doi:10.1002/cmmi.503.
[18]  Triantafyllou, M.; Studer, U.E.; Birkhauser, F.D.; Fleischmann, A.; Bains, L.J.; Petralia, G.; Christe, A.; Froehlich, J.M.; Thoeny, H.C. Ultrasmall superparamagnetic particles of iron oxide allow for the detection of metastases in normal sized pelvic lymph nodes of patients with bladder and/or prostate cancer. Eur. J. Cancer 2013, 49, 616–624, doi:10.1016/j.ejca.2012.09.034.
[19]  Green, D.A.; Durand, M.; Gumpeni, N.; Rink, M.; Cha, E.K.; Karakiewicz, P.I.; Scherr, D.S.; Shariat, S.F. Role of magnetic resonance imaging in bladder cancer: Current status and emerging techniques. BJU Int. 2012, 110, 1463–1470, doi:10.1111/j.1464-410X.2012.11129.x.
[20]  Mertens, L.S.; Bruin, N.M.; Vegt, E.; de Blok, W.M.; Fioole-Bruining, A.; van Rhijn, B.W.; Horenblas, S.; Vogel, W.V. Catheter-assisted 18F-FDG-PET/CT imaging of primary bladder cancer: A prospective study. Nucl. Med. Commun. 2012, 33, 1195–1201, doi:10.1097/MNM.0b013e3283567473.
[21]  Vicente, A.M.; Castrejon, A.S.; Munoz, A.P.; Woll, P.P.; Garcia, A.N. Impact of 18F-FDG PET/CT with retrograde filling of the urinary bladder in patients with suspected pelvic malignancies. J. Nucl. Med. Technol. 2010, 38, 128–137, doi:10.2967/jnmt.109.074146.
[22]  Kibel, A.S.; Dehdashti, F.; Katz, M.D.; Klim, A.P.; Grubb, R.L.; Humphrey, P.A.; Siegel, C.; Cao, D.; Gao, F.; Siegel, B.A. Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J. Clin. Oncol. 2009, 27, 4314–4320, doi:10.1200/JCO.2008.20.6722.
[23]  Lodde, M.; Lacombe, L.; Friede, J.; Morin, F.; Saourine, A.; Fradet, Y. Evaluation of fluorodeoxyglucose positron-emission tomography with computed tomography for staging of urothelial carcinoma. BJU Int. 2010, 106, 658–663, doi:10.1111/j.1464-410X.2010.09212.x.
[24]  Jensen, T.K.; Holt, P.; Gerke, O.; Riehmann, M.; Svolgaard, B.; Marcussen, N.; Bouchelouche, K. Preoperative lymph-node staging of invasive urothelial bladder cancer with 18F-fluorodeoxyglucose positron emission tomography/computed axial tomography and magnetic resonance imaging: Correlation with histopathology. Scand. J. Urol. 2011, 45, 122–128, doi:10.3109/00365599.2010.544672.
[25]  Swinnen, G.; Maes, A.; Pottel, H.; Vanneste, A.; Billiet, I.; Lesage, K.; Werbrouck, P. FDG-PET/CT for the preoperative lymph node staging of invasive bladder cancer. Eur. Urol. 2010, 57, 641–647, doi:10.1016/j.eururo.2009.05.014.
[26]  Apolo, A.B.; Riches, J.; Schoder, H.; Akin, O.; Trout, A.; Milowsky, M.I.; Bajorin, D.F. Clinical value of fluorine-18 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in bladder cancer. J. Clin. Oncol. 2010, 28, 3973–3978, doi:10.1200/JCO.2010.28.7052.
[27]  Jadvar, H.; Quan, V.; Henderson, R.W.; Conti, P.S. [F-18]-Fluorodeoxyglucose PET and PET-CT in diagnostic imaging evaluation of locally recurrent and metastatic bladder transitional cell carcinoma. Int. J. Clin. Oncol. 2008, 13, 42–47, doi:10.1007/s10147-007-0720-8.
[28]  Lu, Y.Y.; Chen, J.H.; Liang, J.A.; Wang, H.Y.; Lin, C.C.; Lin, W.Y.; Kao, C.H. Clinical value of FDG PET or PET/CT in urinary bladder cancer: A systemic review and meta-analysis. Eur. J. Radiol. 2012, 81, 2411–2416, doi:10.1016/j.ejrad.2011.07.018.
[29]  Gofrit, O.N.; Mishani, E.; Orevi, M.; Klein, M.; Freedman, N.; Pode, D.; Shapiro, A.; Katz, R.; Libson, E.; Chisin, R. Contribution of 11C-choline positron emission tomography/computerized tomography to preoperative staging of advanced transitional cell carcinoma. J. Urol. 2006, 176, 940–944, doi:10.1016/j.juro.2006.04.018.
[30]  Maurer, T.; Souvatzoglou, M.; Kubler, H.; Opercan, K.; Schmidt, S.; Herrmann, K.; Stollfuss, J.; Weirich, G.; Haller, B.; Gschwend, J.E.; et al. Diagnostic efficacy of [11C]choline positron emission tomography/computed tomography compared with conventional computed tomography in lymph node staging of patients with bladder cancer prior to radical cystectomy. Eur. Urol. 2012, 61, 1031–1038, doi:10.1016/j.eururo.2011.12.009.
[31]  Golan, S.; Sopov, V.; Baniel, J.; Groshar, D. Comparison of 11C-choline with 18F-FDG in positron emission tomography/computerized tomography for staging urothelial carcinoma: A prospective study. J. Urol. 2011, 186, 436–441, doi:10.1016/j.juro.2011.03.121.
[32]  Orevi, M.; Klein, M.; Mishani, E.; Chisin, R.; Freedman, N.; Gofrit, O.N. 11C-acetate PET/CT in bladder urothelial carcinoma: Intraindividual comparison with 11C-choline. Clin. Nucl. Med. 2012, 37, e67–e72, doi:10.1097/RLU.0b013e31824786e7.
[33]  Schoder, H.; Ong, S.C.; Reuter, V.E.; Cai, S.; Burnazi, E.; Dalbagni, G.; Larson, S.M.; Bochner, B.H. Initial results with 11C-acetate positron emission tomography/computed tomography (PET/CT) in the staging of urinary bladder cancer. Mol. Imaging Biol. 2012, 14, 245–251, doi:10.1007/s11307-011-0488-0.
[34]  Vargas, H.A.; Akin, O.; Schoder, H.; Olgac, S.; Dalbagni, G.; Hricak, H.; Bochner, B.H. Prospective evaluation of MRI, 11C-acetate PET/CT and contrast-enhanced CT for staging of bladder cancer. Eur. J. Radiol. 2012, 81, 4131–4137, doi:10.1016/j.ejrad.2012.06.010.
[35]  Hafeez, S.; Huddart, R. Advances in bladder cancer imaging. BMC Med. 2013, 11, doi:10.1186/1741-7015-11-104.
[36]  Drzezga, A.; Souvatzoglou, M.; Eiber, M.; Beer, A.J.; Furst, S.; Martinez-Moller, A.; Nekolla, S.G.; Ziegler, S.; Ganter, C.; Rummeny, E.J.; et al. First clinical experience with integrated whole-body PET/MR: Comparison to PET/CT in patients with oncologic diagnoses. J. Nucl. Med. 2012, 53, 845–855, doi:10.2967/jnumed.111.098608.
[37]  Judenhofer, M.S.; Wehrl, H.F.; Newport, D.F.; Catana, C.; Siegel, S.B.; Becker, M.; Thielscher, A.; Kneilling, M.; Lichy, M.P.; Eichner, M.; et al. Simultaneous PET-MRI: A new approach for functional and morphological imaging. Nat. Med. 2008, 14, 459–465.


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