Conventional and innovative imaging modalities in bladder cancer: Techniques and applications

This narrative review describes the current status of imaging in the evaluation of bladder cancer, considering conventional technologies such as ultrasonography, computed tomography urography, and magnetic resonance imaging, as well as novel technologies such as contrast-enhanced ultrasonography and dual-energy computed tomography.

The article is organized by first presenting an introduction on both the anatomy of the bladder (to understand its normal appearance on imaging) and the main features of bladder cancer with reference to epidemiology, clinical picture, classification, and treatment. Subsequently, the role of imaging is discussed, with an explanation of the technique and applications in bladder cancer assessment for each modality.

Imaging plays a critical role in the detection and staging of bladder cancer. In particular, the role of magnetic resonance imaging is expanding because it enables differentiating muscle-invasive bladder cancer from non-muscle-invasive bladder cancer using the Vesical Imaging-Reporting and Data System (VI-RADS), along with conventional technologies, such as computed tomography urography and ultrasonography. Contrast-enhanced ultrasound and dual-energy computed tomography are new imaging modalities that offer special advantages and provide the right approach to patients with oncological conditions. This review ends with the presentation of integrated imaging modalities such as positron emission tomography combined with computed tomography or magnetic resonance imaging, which are promising methods for bladder cancer staging.