{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T22:51:16Z","timestamp":1779317476363,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early bladder cancer on CT\/MRI scans performed for other indications are emerging in the literature. This represents a new opportunity for early detection, with over 80 million CT scans performed in the US yearly, 40% of which are abdominopelvic CTs. This investigation aims to define the imaging features of early bladder cancer, with the mission of facilitating early diagnosis. Methods: Following IRB approval with a waiver of informed consent, a retrospective review was performed, identifying 624 patients with non-muscle-invasive bladder cancer diagnosed at Johns Hopkins Hospital between 2000 and 2019. Of these patients, 99 patients underwent pelvic CT within the 5 years preceding pathologic diagnosis. These imaging studies were reviewed retrospectively to evaluate for the presence and features of any focal bladder wall abnormality. Results: Median age at the time of pathologic diagnosis was 70 years (range: 51\u201388 years), and 82% (81\/99) of patients were male. A total of 226 CT studies were reviewed. The number of studies per patient ranged from 1 to 33. Median time interval between all available imaging and pathologic diagnosis was 14 months. A total of 62% (141\/226) of the scans reviewed were performed for indications other than suspected urinary tract cancer (UTC). A bladder wall mass was visualized in 67% (66\/99) of patients and on 35% (78\/226) of scans performed before diagnosis. The majority (84%, 67\/80) of masses were intraluminal. Mean transverse long- and short-axis measurements were 24 mm and 17 mm, respectively, with long dimension measurements ranging between 5 and 59 mm. Conclusions: Early bladder cancer was visualized on CT preceding pathologic diagnosis in more than 2\/3 of patients, and the majority of scans were performed for indications other than suspected urinary tract cancer\/UTC symptoms. These results suggest that cross-sectional imaging performed for other indications can serve as a resource for opportunistic bladder cancer screening, particularly in high-risk patients.<\/jats:p>","DOI":"10.3390\/tomography9050138","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T10:42:49Z","timestamp":1694428969000},"page":"1734-1744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis"],"prefix":"10.3390","volume":"9","author":[{"given":"Rubab F.","family":"Malik","sequence":"first","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renu","family":"Berry","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandyn D.","family":"Lau","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran R.","family":"Busireddy","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasan","family":"Patel","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil H.","family":"Patel","sequence":"additional","affiliation":[{"name":"Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2567-1658","authenticated-orcid":false,"given":"Elliot K.","family":"Fishman","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trinity J.","family":"Bivalacqua","sequence":"additional","affiliation":[{"name":"Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela T.","family":"Johnson","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9067-3684","authenticated-orcid":false,"given":"Farzad","family":"Sedaghat","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.eururo.2015.08.037","article-title":"Gender and Bladder Cancer: A Collaborative Review of Etiology, Biology, and Outcomes","volume":"69","author":"Dobruch","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.euo.2020.02.010","article-title":"Distribution of Molecular Subtypes in Muscle-invasive Bladder Cancer Is Driven by Sex-specific Differences","volume":"3","author":"Boormans","year":"2020","journal-title":"Eur. Urol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.eururo.2011.10.029","article-title":"Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Gu\u00e9rin","volume":"62","author":"Palou","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s00345-011-0773-1","article-title":"Gender-dependent cancer-specific survival following radical cystectomy","volume":"30","author":"May","year":"2012","journal-title":"World J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3233\/BLC-189035","article-title":"Financial Toxicity of Having Bladder Cancer","volume":"4","author":"Messing","year":"2018","journal-title":"Bladder Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1001\/jama.2011.1142","article-title":"Association between smoking and risk of bladder cancer among men and women","volume":"306","author":"Freedman","year":"2011","journal-title":"JAMA"},{"key":"ref_8","first-page":"1","article-title":"Bladder cancer","volume":"3","author":"Sanli","year":"2017","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.eururo.2012.07.033","article-title":"Bladder Cancer Epidemiology and Risk Factors of Urothelial Bladder Cancer","volume":"63","author":"Burger","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.juro.2011.10.157","article-title":"Long-term impact of arsenic in drinking water on bladder cancer health care and mortality rates 20 years after end of exposure","volume":"187","author":"Vivaldi","year":"2012","journal-title":"J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1136\/oem.2007.035816","article-title":"Occupation and bladder cancer in a hospital-based case-control study in Spain","volume":"65","author":"Samanic","year":"2008","journal-title":"Occup. Environ. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1001\/jama.2020.17598","article-title":"Bladder cancer a review","volume":"324","author":"Lenis","year":"2020","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.eururo.2015.06.042","article-title":"The Role of Tobacco Smoke in Bladder and Kidney Carcinogenesis: A Comparison of Exposures and Meta-analysis of Incidence and Mortality Risks","volume":"70","author":"Cumberbatch","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1002\/1097-0215(200002)9999:9999<::AID-IJC1092>3.0.CO;2-S","article-title":"Use of permanent hair dyes and bladder-cancer risk","volume":"91","author":"Castelao","year":"2001","journal-title":"Int. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"djv223","DOI":"10.1093\/jnci\/djv223","article-title":"Modification of Occupational Exposures on Bladder Cancer Risk by Common Genetic Polymorphisms","volume":"107","author":"Figueroa","year":"2015","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_16","first-page":"60","article-title":"Global, regional, and national burden of kidney, bladder, and prostate cancers and their attributable risk factors, 1990\u20132019","volume":"8","author":"Zi","year":"2021","journal-title":"Mil. Med. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"123","DOI":"10.14740\/wjon1210","article-title":"Non-Muscle Invasive Bladder Cancer: A Review of the Current Trend in Africa","volume":"10","author":"Cassell","year":"2019","journal-title":"World J. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.juro.2017.04.086","article-title":"Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA\/ASCO\/ASTRO\/SUO Guideline","volume":"198","author":"Chang","year":"2017","journal-title":"J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.eururo.2005.12.031","article-title":"Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: A combined analysis of 2596 patients from seven EORTC trials","volume":"49","author":"Sylvester","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1016\/j.juro.2007.09.003","article-title":"Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 Update","volume":"178","author":"Hall","year":"2007","journal-title":"J. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1148\/radiol.2532082010","article-title":"Radiologic and Nuclear Medicine Studies in the United States and Worldwide: Frequency, Radiation Dose, and Comparison with Other Radiation Sources\u20141950\u20132007","volume":"253","author":"Mettler","year":"2009","journal-title":"Radiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1177\/2051415819847070","article-title":"Incidental urological findings in patients undergoing computed tomography colonography for investigation of suspected colorectal cancer","volume":"12","author":"Ahmad","year":"2019","journal-title":"J. Clin. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s11547-010-0557-5","article-title":"Prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta and lower limbs","volume":"115","author":"Belgrano","year":"2010","journal-title":"Radiol. Medica"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"20190344","DOI":"10.1259\/bjr.20190344","article-title":"Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: Single centre experience and review of the literature","volume":"92","author":"Hinton","year":"2019","journal-title":"Br. J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.jemermed.2008.01.021","article-title":"Frequency and Follow-up of Incidental Findings on Trauma Computed Tomography Scans: Experience at a Level One Trauma Center","volume":"38","author":"Munk","year":"2010","journal-title":"J. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"316","DOI":"10.5152\/dir.2018.18102","article-title":"Incidental bladder cancers found on multiparametric MRI of the prostate gland: A single center experience","volume":"24","author":"Rayn","year":"2018","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"535","DOI":"10.3389\/fmed.2020.00535","article-title":"FDG-PET\/CT Incidental Detection of Cancer in Patients Investigated for Infective Endocarditis","volume":"7","author":"Gouriet","year":"2020","journal-title":"Front. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e028362","DOI":"10.1136\/bmjopen-2018-028362","article-title":"Incidentally diagnosed cancer and commonly preceding clinical scenarios: A cross-sectional descriptive analysis of English audit data","volume":"9","author":"Koo","year":"2019","journal-title":"BMJ Open"},{"key":"ref_29","first-page":"w20154","article-title":"Incidental findings during computed tomographic angiography diagnostic work-up in patients with arteriogenic erectile dysfunction","volume":"149","author":"Mohan","year":"2019","journal-title":"Swiss Med. Wkly."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s42155-018-0016-2","article-title":"Incidental extravascular findings in CT angiograms in patients post endovascular abdominal aortic aneurysm repair: Clinical relevance and frequency","volume":"1","author":"Dhillon","year":"2018","journal-title":"CVIR Endovasc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e000855","DOI":"10.1136\/openhrt-2018-000855","article-title":"Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: Incidence and implications","volume":"5","author":"Patel","year":"2018","journal-title":"Open Heart"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1148\/rg.262055172","article-title":"From the Archives of the AFIP: Neoplasms of the urinary bladder: Radiologic-pathologic correlation","volume":"26","author":"Woodward","year":"2006","journal-title":"Radiographics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s00330-015-3844-7","article-title":"Comparison of post contrast CT urography phases in bladder cancer detection","volume":"26","author":"Helenius","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/003655902320131839","article-title":"Urinary bladder volume measurements: Comparison of three ultrasound calculation methods","volume":"36","author":"Hvarness","year":"2002","journal-title":"Scand. J. Urol. Nephrol."},{"key":"ref_35","first-page":"503","article-title":"Nonsmoking-related arylamine exposure and bladder cancer risk","volume":"12","author":"Skipper","year":"2003","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1102\/1470-7330.2011.0017","article-title":"Urinary bladder: Normal appearance and mimics of malignancy at CT urography","volume":"11","author":"Shinagare","year":"2011","journal-title":"Cancer Imaging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/00004728-200307000-00020","article-title":"Bladder imaging using multidetector row computed tomography, volume rendering, and magnetic resonance imaging","volume":"27","author":"Lawler","year":"2003","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Tseng, C.-H. (2013). Benign prostatic hyperplasia is a significant risk factor for bladder cancer in diabetic patients: A population-based cohort study using the National Health Insurance in Taiwan. BMC Cancer, 13.","DOI":"10.1186\/1471-2407-13-7"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1038\/sj.bjc.6603730","article-title":"Benign prostatic hyperplasia and subsequent risk of bladder cancer","volume":"96","author":"Kang","year":"2007","journal-title":"Br. J. Cancer"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s00345-018-2216-8","article-title":"Association of benign prostatic hyperplasia and subsequent risk of bladder cancer: An Asian population cohort study","volume":"36","author":"Fang","year":"2018","journal-title":"World J. Urol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1038\/s41568-018-0016-5","article-title":"Artificial intelligence in radiology","volume":"18","author":"Hosny","year":"2018","journal-title":"Nat. Rev. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"421","DOI":"10.18383\/j.tom.2016.00184","article-title":"Bladder Cancer Segmentation in CT for Treatment Response Assessment: Application of Deep-Learning Convolution Neural Network\u2014A Pilot Study","volume":"2","author":"Cha","year":"2016","journal-title":"Tomography"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"103601","DOI":"10.1016\/j.critrevonc.2022.103601","article-title":"Artificial intelligence: A promising frontier in bladder cancer diagnosis and outcome prediction","volume":"171","author":"Borhani","year":"2022","journal-title":"Crit. Rev. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1159\/000521684","article-title":"The Clinical Features of Incidentally Diagnosed Urothelial Bladder Cancer: A Retrospective Data Analysis","volume":"106","author":"Kamecki","year":"2022","journal-title":"Urol. Int."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Kamecki, H., D\u0119bowska, M., Poleszczuk, J., Demkow, T., Przewor, A., Nyk, \u0141., and Sosnowski, R. (2023). Incidental Diagnosis of Urothelial Bladder Cancer: Associations with Overall Survival. Cancers, 15.","DOI":"10.3390\/cancers15030668"}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/9\/5\/138\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:48:48Z","timestamp":1760129328000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/9\/5\/138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,11]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["tomography9050138"],"URL":"https:\/\/doi.org\/10.3390\/tomography9050138","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,11]]}}}