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Imaging of Bladder Cancer Jingbo Zhang, MDa,*, Scott Gerst, MDb, Robert A. Lefkowitz, MDa, Ariadne Bach, MDb Bladder cancer is the fourth most common cancer in men and the tenth most common cancer in women in the United States, with 61,420 new diag- noses and 13,060 deaths expected to occur in 2006 [1]. According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, between 1998 and 2002, the age-adjusted incidence and death rates for bladder cancer were 21.3 and 4.4 per 100,000 population, respectively. Between 1995 and 2001, the overall 5-year survival rate for bladder cancer was 81.8% [2]. Bladder cancers occur three to four times more often in men than in women [2,3]. The age at diagnosis is generally older than 40 years; the me- dian age is in the mid-60s. The urinary bladder is an extraperitoneal struc- ture surrounded by pelvic fat. The peritoneum forms a serosal covering that is present only over the bladder dome. The bladder wall consists of four layers: uroepithelium lining the bladder lu- men, the vascular lamina propria, the muscularis propria consisting of bundles of smooth detrusor muscle, and the outermost adventitia formed by connective tissue [4]. More than 95% of bladder tumors arise from the uroepithelium (epithelial tumors), including urothelial tumors (over 90%), squamous cell carcinomas (6% to 8%), and adenocarcinomas (2%) [5,6]. Urothelial tumors (or transitional cell carcinoma, TCC) exhibit a spectrum of neoplasia rang- ing from a benign papilloma through carcinoma in situ to invasive carcinoma [5]. Adenocarcinomas may be of urachal origin or of nonurachal origin [7], with the urachal type typically occurring in the dome of the bladder in the embryonal remnant of the urachus [8]. Squamous cell carcinoma is associated strongly with a history of recurrent urinary tract infection or bladder calculus [9]. Much rarer epithelial tumors include small cell/neuroendo- crine carcinoma (1%, with or without associated paraneoplastic syndrome), carcinoid tumors, and melanoma [10]. Epithelial tumors may have a mixed histology, such as urothelial and squamous or urothelial and adenocarcinoma. These are treated as urothelial carcinomas [11]. Mesenchymal bladder tumors can be benign (leio- myoma, paraganglioma, fibroma, plasmacytoma, hemangioma, solitary fibrous tumor, neurofibroma, R A D I O L O G I C C L I N I C S O F N O R T H A M E R I C A Radiol Clin N Am 45 (2007) 183–205 a Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C278D, New York, NY 10021, USA b Cornell University, Weill Medical College, New York, NY, USA * Corresponding author. Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C278D, New York, NY 10021. E-mail address: