Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Department of Radiology, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
J Cancer Res Clin Oncol. 2023 Mar;149(3):1221-1230. doi: 10.1007/s00432-022-03996-1. Epub 2022 Apr 7.
Concerns of imaging-related radiation exposure 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.
A prospective, non-inferiority study of 84 consecutive patients (median age 33 years) with newly diagnosed metastatic TC (February 2018-January 2021). 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, specificity, positive predictive value, negative predictive value and accuracy were calculated on patient and lesion level. The primary outcome was demonstrating non-inferiority regarding sensitivity of MRI compared to CT. The non-inferiority margin was set at 5%. ROC curves and interobserver agreement were calculated.
On patient level, MRI had 98% sensitivity and 75% specificity compared to CT. On lesion level within each modality, MRI had 99% sensitivity and 78% specificity, whereas CT had 98% sensitivity and 88% specificity. 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.
MRI with DWIBS was non-inferior to contrast-enhanced CT in detecting metastatic TC disease.
www.
gov NCT03436901, finished July 1st 2021.
由于对生存率较高的年轻患者的影像学相关辐射暴露的担忧增加，磁共振成像（MRI）在 I 期睾丸癌（TC）中的应用增加。然而，计算机断层扫描（CT）仍然是转移性 TC 的首选方法。本研究旨在比较全身 MRI 包括弥散加权全身成像与背景抑制（DWIBS）与增强后胸腹 CT 在转移性 TC 中的应用。
这是一项连续 84 例新诊断为转移性 TC（2018 年 2 月至 2021 年 1 月）患者的前瞻性非劣效性研究。患者在治疗前后均行 MRI 和 CT 检查。有经验的放射科医生对匿名图像进行了回顾。病变恶性程度采用 Likert 量表（1 良性-4 恶性）进行评估。在患者和病变水平上计算了灵敏度、特异性、阳性预测值、阴性预测值和准确性。主要结局是证明 MRI 的敏感性不劣于 CT。非劣效性边界设定为 5%。计算 ROC 曲线和观察者间一致性。
在患者水平上，MRI 的敏感性为 98%，特异性为 75%，而 CT 为 98%和 75%。在每种方法的病变水平上，MRI 的敏感性为 99%，特异性为 78%，而 CT 为 98%和 88%。MRI 的敏感性不劣于 CT（差异 0.57%（95%CI-1.4-2.5%））。CT 和 MRI 之间的观察者间一致性较高。
DWIBS 全身 MRI 在检测转移性 TC 疾病方面不劣于增强 CT。
www.clinicaltrials.gov NCT03436901，于 2021 年 7 月 1 日完成。
