Computed Tomography and Magnetic Resonance Imaging before Salvage Cystectomy

Nine patients who developed recurrence of bladder carcinoma following radical radiotherapy were assessed for salvage cystectomy by computed tomography (CT) and magnetic resonance imaging (MRI) to predict extravesical spread. Both tests correctly identified a patient with such advanced local disease that surgery was deemed inappropriate at examination under anaesthesia and both tests indicated that surgery might be difficult in a further patient with inoperable disease. Both tests demonstrated abnormalities in the perivesical and pelvic fat planes in all patients but they had difficulty in distinguishing between malignant infiltration and the effects of radiotherapy. Nevertheless, each test is useful in excluding gross pelvic disease and predicting involvement of adjacent organs. The advantages of the multiplanar images provided by MRI must be balanced against the high cost. CT readily demonstrates the upper abdomen, the kidneys and para-aortic nodes as well as the pelvis and is more widely available.