Figure 11.15 T3b N2 Bladder Cancer.

(a) and (b) Transaxial T2W1 and (c) coronal T2W1. A bladder tumor (T) is extending into perivesical fat

(arrow) and obstructing the right ureter (arrowhead). There is a right obturator lymph node metastasis (N) with a maximum diameter between 2.0 and 5.0 cm.A

Figure 11.16. T3b N3 Bladder cancer.

Coronal T2W1 showing a large bladder tumour (T) extending into the perivesical fat. There is a right external iliac node (N), >5.0 cm in longest dimension and of identical signal intensity to the primary tumour.

Figure 11.17. M1 Bladder cancer.

Coronal T1W1 showing multiple para-aortic (arrows) and aortocaval (open arrow) lymph node metastases.

Common iliac and retroperitoneal nodes are considered to be distant metastases (MI1) in the TNM staging of bladder

Figure 11.18. M1 Bladder cancer—bone metastasis.

Transaxial T1W1 through the pelvis showing an intermediate signal mass (M) In the body of the sacrum due to a bone metastasis from the patient's transitional cell bladder tumour.

Figure 11.19. Post biopsy effect.

(a) and (b) Sagittal T2W1 through the bladder. In (a) there is extensive abnormality of the bladder wall with intermediate signal thickening (open arrows), predominantly posteriorly with associated stranding of the perivesical fat (arrow), suggesting a T3b tumour. Thickening and irregularity of the bladder mucosa (arrowhead) is also noted. (b) Three months later these appearances have virtually resolved with no intervention and were due to biopsy-induced inflammation and oedema.

Figure 11.20. Multifocal bladder cancer.

(a) Sagittal T2W1 and (b) coronal T2W1.There are multiple nodules of intermediate signal tumour involving the superficial bladder muscle (arrows). Some lesions show extension through the deep muscle layers (open arrow).Tumour (T) is also noted to extend into the defect (D) from a transurethral resection of the prostate for benign prostatic hypertrophy.

Figure 11.21. Multifocal bladder cancer.

(a) Transaxial T2W1 and (b) coronal T2W1 showing multiple areas of intermediate signal intensity tumour, involving the superficial bladder muscle (arrows). Some lesions show extension through the deep muscle layer (open arrow).There is also evidence of bladder mucosal oedema (arrowhead), which appears as superficial high signal.

Figure 11.22. Diffuse bladder cancer with layering.

Transaxial T2W1 through the bladder. Extensive tumour (T) is seen spreading circumferentially around the bladder wall with components superficial and deep to the muscle layer, which appears intact between them (arrowheads). This is therefore T3b disease. Small perivesical and pelvic sidewall nodes (N) are noted.

Figure 11.23. T3b Bladder cancer with tumour extending into the left ureter.

(a) Sagittal T2W1 and (b) coronal T2W1 through the bladder demonstrate a T3b tumour (T) involving the left bladder wall and base and extending into the lower left ureter. There is a left sided hydroureter (H) with layering of urine and debris or haemorrhage seen in the ureter (arrow). Hydronephrosis and/or tumour extension into the ureter do not alter the tumour stage but are associated with a worse prognosis.

Figure 11.24. Urachal cancer.

(a) Sagittal T2W1 and (b) transaxial T2W1 showing tumour (T) centred on the obliterated urachus (median umbilical ligament), adjacent to the anterior bladder wall. The epicentre is extra-luminal, but knowledge of this anatomy allows the correct diagnosis of a urachal tumour, most commonly an adenocarcinoma.

Figure 11.25. Treatment related change following cystectomy and radiotherapy.

Sagittal T2W1. A small post-operative fluid collection (asterisk) is seen in the bladder bed and there are low signal fibrotic bands causing tethering of the sigmoid colon (arrow).

Figure 11.26. Treatment related change following localised radiotherapy.

Transaxial T2W1 showing low signal thickening of the left postero-lateral bladder wall (arrow) due to fibrosis and resulting in left-sided hydronephrosis (asterisk). The bladder is tethered to the anterior vagina (open arrow).

Figure 11.27. Tumour recurrence post cystectomy.

Transaxial T2W1 in a patient who had a previous cystectomy for bladder cancer demonstrating an intermediate signal tumour recurrence (R) in the urethral bed and a bone metastasis in the left inferior pubic ramus

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