Can whole-body MRI replace CT in management of metastatic testicular cancer? A prospective, non-inferiority study

Abstract

Purpose Concerns of imaging-related radiation in young patients with high survival rates have increased the use of magnetic resonance imaging (MRI) in testicular cancer (TC) stage I. However, computed tomography (CT) is still preferred for metastatic TC.The purpose of this study was to compare whole-body MRI incl. diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) with contrast-enhanced, thoracoabdominal CT in metastatic TC.Methods A prospective, non-inferiority study of 84 consecutive patients (median age 33 years) with newly diagnosed metastatic TC (February 2018 -January 2021). Exclusion criteria were age <18 years, claustrophobia and MRI contraindications. Patients had both MRI and CT before and after treatment. Anonymised images were reviewed by experienced radiologists.Lesion malignancy was evaluated on a Likert scale (1 benign -4 malignant). Sensitivity, speci city, positive predictive value, negative predictive value and accuracy were calculated on patient and lesion level. For non-inferiority testing, the difference in sensitivity between CT and MRI was calculated. The level of signi cance was set at 5%. ROC curves and interobserver agreement were calculated.Results On patient level, MRI had 98% sensitivity and 75% speci city compared to CT. On lesion level within each modality, MRI had 99% sensitivity and 78% speci city, whereas CT had 98% sensitivity and 88% speci city. MRI sensitivity was non-inferior to CT (difference 0.57% (95% CI -1.4-2.5%)). The interobserver agreement was substantial between CT and MRI.Conclusion MRI with DWIBS was non-inferior to contrast-enhanced CT in detecting metastatic TC disease.Trial registration www.clinicaltrials.gov NCT03436901, nished July 1 st 2021.

German specialists treating testicular cancer follow different guidelines with resulting inconsistency in assessment of retroperitoneal lymph-node metastasis: clinical implications and possible corrective measures

“…This is not only important for patients with contraindications to CT imaging, such as chronic kidney disease or allergies to radiocontrast agents, but also to reduce radiation exposure and the risk of developing secondary malignancies in the mainly young patients [ 24 , 25 ]. Recent prospective studies suggest an equal detection rate of retroperitoneal lymph-node metastasis with MRI as with CT for experienced radiologists [ 13 , 14 , 26 ]. Because MRIs are still not as widely available as CTs and cost more time and money, widespread use for initial staging and follow-up may still take some time.…”

Diagnostic Value of Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) for the Pre-Therapeutic Loco-Regional Staging of Cervical Cancer: A Feasibility and Interobserver Reliability Study

“…Through the black-and-white reversal technology, DWIBS could achieve a similar effect with positron emission tomography (PET) and obtain PET-like images. DWIBS has been widely applied in the clinical diagnosis of brain, nerve and abdomino-pelvic diseases as well as in the staging routine of multiple different cancerous entities [21][22][23][24][25][26][27][28][29]. A larger field of view facilitates the detection of lymph nodes in the pelvic and para-aortic region with an accuracy of 97 and 67%, respectively.…”

Additional Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) Improves Pre-Therapeutical Detection of Early-Stage (pT1a) Glottic Cancer: A Feasibility and Interobserver Reliability Study

“…Through the black-and-white reversal technology, DWIBS obtains PET-like images. DWIBS has been widely applied in the clinical diagnosis of brain, nerve, and abdominopelvic diseases, as well as in the staging routine of various cancer entities [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”