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Background: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) remains standard treatment for select patients with muscle-invasive bladder cancer (MIBC). Although computed tomography (CT) is often obtained prior to RC, its ability to predict pathologic response is poorly characterized., Objective: The purpose of this study is to evaluate the predictive value of CT in assessing disease burden after NAC., Methods: Patients with MIBC having received NAC prior to RC were identified. Pre- and post-NAC CT scans were reviewed by an abdominal radiologist. The correlation between pathologic complete response (PCR) and radiologic complete response (RCR) was determined as the primary aim. As a secondary aim, the correlation between pathologic partial response (PPR) and radiologic partial response (RPR) was determined. Logistic regression analysis was utilized to determine the predictive value of CT in determining disease burden at RC., Results: A total of 141 patients were identified for analysis. PCR and PPR was achieved in 34% and 16% of patients, respectively. The positive predictive value of post-NAC CT was 53.5% for PCR and 28.8% for PPR. The negative predictive value of post-NAC CT was 73.5% for PCR and 46.2% for PPR. There was no significant association between RCR and PCR (OR 1.13, p  = 0.67). Similarly, there was no meaningful association between RPR and PPR, lymph node involvement, or presence of extravesical disease., Conclusions: CT findings correlate poorly with final pathology at RC and should not be used to evaluate local disease burden., Competing Interests: John A. Taylor III is an Editorial Board member of this journal but was not involved in the peer-review process nor had access to any information regarding its peer-review. The remainder of the authors (S.A., A.M., M.M., H.S., M.G., J.T., M.S., S.B.) report no conflicts of interest., (© 2023 – The authors. Published by IOS Press.)