Hansen J, Jurik A G
Department of Medical Physics, Aarhus University Hospital, Aarhus Sygehus, Aarhus, Denmark.
Acta Radiol. 2009 Nov;50(9):1064-70. doi: 10.3109/02841850903220371.
Testicular cancer is the most frequent malignant disorder in men aged 15-35 years. Generally, diagnosing and follow-up include computer tomography (CT) examinations to detect possible retroperitoneal spread (abdomen and pelvis), resulting in at least eight CT examinations. This patient group is thereby exposed to a non-neglectable radiation dose, increasing the risk of future radiation-induced secondary cancer. This is especially problematic in potentially surgically cured patients with stage 1 testicular cancer. Thus, it can be beneficial to substitute CT with magnetic resonance imaging (MRI), provided there is valid evidence that the diagnostic value of MRI is at least comparable to current multislice CT (MSCT). The purpose of this study was to analyze whether there is evidence to recommend a substitution of MSCT with MRI in the diagnosis of retroperitoneal spread of testicular cancer. A literature search on the diagnostic accuracy, specificity, and sensitivity of MSCT and MRI in the diagnosis of retroperitoneal spread of testicular cancer was performed in the following databases: PubMed, EmBase, and ISI Web of Science. The search was limited to include the period from 2000 to September 2008, and to human and English-language publications. Forty-four publications were obtained for formal review (27 from PubMed, 15 from EmBase, two from ISI Web of Science). None of the publications reviewed encompassed diagnostic specificity and sensitivity of MSCT, and they lacked systematic comparison of MSCT and MRI. Only one study included sensitivity and specificity of MRI compared to single-slice CT. Both methods had a sensitivity and a specificity of approximately 70%. The literature review did not reveal valid data regarding diagnostic accuracy of MRI compared with MSCT for diagnosing retroperitoneal spread of testicular cancer. A prospective blinded comparative study is needed to provide valid evidence.
睾丸癌是15至35岁男性中最常见的恶性疾病。一般来说，诊断和随访包括计算机断层扫描（CT）检查，以检测可能的腹膜后扩散（腹部和骨盆），这至少需要进行八次CT检查。因此，该患者群体暴露于不可忽视的辐射剂量下，增加了未来发生辐射诱发继发性癌症的风险。这在1期睾丸癌潜在可手术治愈的患者中尤其成问题。因此，如果有有效证据表明磁共振成像（MRI）的诊断价值至少与当前的多层螺旋CT（MSCT）相当，那么用MRI替代CT可能是有益的。本研究的目的是分析是否有证据建议在睾丸癌腹膜后扩散的诊断中用MRI替代MSCT。我们在以下数据库中对MSCT和MRI在睾丸癌腹膜后扩散诊断中的诊断准确性、特异性和敏感性进行了文献检索：PubMed、EmBase和科学引文索引（ISI）数据库。检索限于2000年至2008年9月期间，且仅限于人类和英文出版物。共获得44篇出版物进行正式审查（27篇来自PubMed，15篇来自EmBase，2篇来自ISI数据库）。所审查的出版物均未涵盖MSCT的诊断特异性和敏感性，且缺乏MSCT与MRI的系统比较。只有一项研究纳入了与单层CT相比MRI的敏感性和特异性。两种方法的敏感性和特异性均约为70%。文献综述未揭示与MSCT相比MRI在诊断睾丸癌腹膜后扩散方面的有效诊断准确性数据。需要进行一项前瞻性双盲对照研究以提供有效证据。
