Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Germany.
J Dtsch Dermatol Ges. 2011 Mar;9(3):212-22. doi: 10.1111/j.1610-0387.2011.07614.x.
Malignant melanoma (MM) is dramatically increasing in light-skinned populations worldwide. Staging and regular follow-up examinations are essential. The purpose of this study was to compare the diagnostic accuracy of whole-body MRI with the standard diagnostic algorithm (whole-body CT and brain MRI) in patients with stage III/IV MM.
A group of 50 consecutively admitted patients with stage III/IV MM were included in the study. Whole-body CT and brain MRI scans were performed. Additionally, all patients underwent a whole-body MRI (1.5 Tesla Magnetom Avanto, Siemens Healthcare Sector, Erlangen). The findings were compared on a lesion-by-lesion basis as part of clinical routine follow-up.
33 patients received a follow-up CT and were evaluated. Overall, 824 lesions were detected. The sensitivity of whole-body MRI was observer-dependent. MRI was slightly less sensitive than CT according to the findings of the two most experienced observers (73.4 % vs. 78.2 %, p = 0.0744). CT was significantly more sensitive in the detection of small (1-5 mm) pulmonary nodules (2.9 % vs. 66.9 %, p < 0.0001). Yet overall, MRI was significantly more specific than CT (83.4 % vs. 50.4 %, p < 0.0001).
Whole-body MRI in compliance with standard requirements for the observers (high level of experience) should be considered as an appropriate alternative to CT without ionizing radiation, particularly for young patients with advanced MM.
恶性黑色素瘤（MM）在世界各地的浅色皮肤人群中急剧增加。分期和定期随访检查至关重要。本研究的目的是比较全身 MRI 与标准诊断算法（全身 CT 和脑 MRI）在 III/IV 期 MM 患者中的诊断准确性。
本研究纳入了 50 例连续入院的 III/IV 期 MM 患者。进行全身 CT 和脑 MRI 扫描。此外，所有患者均进行全身 MRI（1.5T Magnetom Avanto，西门子医疗集团，埃尔朗根）。作为临床常规随访的一部分，对病变进行逐点比较。
33 例患者接受了随访 CT 检查并进行了评估。总共发现 824 个病灶。全身 MRI 的灵敏度取决于观察者。根据两位经验最丰富的观察者的发现，MRI 的灵敏度略低于 CT（73.4%对 78.2%，p=0.0744）。CT 在检测小（1-5mm）肺结节方面明显更敏感（2.9%对 66.9%，p<0.0001）。然而，总体而言，MRI 的特异性明显高于 CT（83.4%对 50.4%，p<0.0001）。
符合观察者高标准要求（高经验水平）的全身 MRI 应被视为无电离辐射的 CT 的合适替代方案，特别是对于晚期 MM 的年轻患者。
