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figure 31.8. Bladder cancer. Axial Tj-weighted MR image with fat suppression obtained after gadolinium contrast agent injection shows multifocal masses arising from the anterior and right lateral wall of the bladder projecting into the bladder lumen.

Patients with bladder cancer and lymph node metastases have a worse prognosis than those without metastatic nodes. Reported accuracy of CT and MRI in detecting lymph node metastasis is similar, ranging from 70% to 98%.49 Three-dimensional magnetization prepared rapid acquisition gradient echo (MP-RAGE) images have improved the detection of suspicious lymph nodes.50,51 Lymphotrophic contrast agents, such as ultrasmall superparamagnetic iron oxide (USPIO) may improve distinguishing between benign and malignant lymph nodes.52

Inflammation of the bladder wall after radiotherapy or other causes may be indistinguishable from neoplastic infiltration as both may enhance substantially. A study showed that early-phase dynamic gadolinium-enhanced imaging improved distinction of tumor and postbiopsy changes of the bladder wall because bladder cancer enhanced earlier (6.5 seconds) than postbiopsy inflammation and granulation tissue (13.6 seconds) after gadolinium contrast administration.53

Virtual cystoscopy created with CT or MR data has recently been used to detect bladder cancer. Recent studies of virtual cystoscopy created with CT data showed a sensitivity of 89% to 100% compared with fiberoptic cystoscopy.54-56 Most tumors not detected by virtual cystoscopy were reported to be less than 1 cm.

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