GBCI Virtual Grand Rounds | It’s Endless: Tests, Scans, MRI’s, Ultrasounds and More Tests

Why It Matters

Accurate, efficient imaging directly influences bladder cancer staging and treatment choices, improving outcomes while minimizing patient burden.

Key Takeaways

• Bladder cancer imaging relies mainly on CT and MRI, not ultrasound.
• Multiparametric MRI improves differentiation of muscle‑invasive vs non‑muscle‑invasive disease.
• Post‑TURBT MRI sensitivity rises, but specificity may decline due to treatment changes.
• Johns Hopkins protocol balances yield with 30‑minute scan for elderly.
• Ktrans and diffusion metrics show promise for distinguishing tumor grade and aggressiveness.

Summary

The virtual Grand Rounds session tackled the overwhelming array of imaging studies—CT, MRI, ultrasound—used in bladder and upper‑tract carcinoma management. Dr. Fzad Setahhat, an assistant professor of radiology at Johns Hopkins, outlined why imaging, though less central than in other cancers, remains critical for staging and treatment planning.

Key insights included the epidemiology of bladder cancer, the predominance of CT and multiparametric MRI over ultrasound, and the protocol’s focus on distinguishing non‑muscle‑invasive from muscle‑invasive disease. Advanced MRI techniques such as diffusion‑weighted imaging and Ktrans perfusion metrics improve sensitivity after transurethral resection, though specificity can suffer from post‑treatment changes.

Dr. Setahhat emphasized that radiologists are often “the least involved” in bladder cancer care, underscoring the need for structured reporting. He highlighted a 3‑mm lesion case where rapid post‑contrast acquisition revealed subtle enhancement, and cited a NYU study showing Ktrans values nearly double in malignant versus benign bladder tissue.

The refined 30‑minute MRI protocol, now deployed across the Johns Hopkins system, balances diagnostic accuracy with patient comfort—especially for elderly men with limited bladder distension tolerance. Wider adoption could streamline staging, reduce unnecessary procedures, and better guide intravesical versus surgical therapies.

Original Description

Farzad Sedaghat, MD, Section Chief of Ultrasound and Assistant Professor of Radiology and Radiological Science, shares what these tests mean, what they are for, what they show and why so many. Presented with step-by-step examples to debunk and demystify this stressful yet necessary aspect of bladder and UTUC treatments. #johnshopkinsmedicine #bladdercancer