MRI Could Replace CT for Detecting Metastatic Testicular Cancer

M. Alexander Otto, MMS, PA

January 14, 2022

This study, published on researchsquare.com as a preprint and not yet peer reviewed, found no meaningful loss of sensitivity with MRI compared with CT, and utilizing the MRI eliminates radiation exposure.

Key Takeaway

  • Whole body MRI is as sensitive at thoracoabdominal CT for detecting metastatic testicular cancer.

Why This Matters

  • Imaging for stage 1 testicular cancer is shifting away from serial CTs toward MRIs to save patients from radiation exposure. 

  • The new findings suggest that MRI could potentially replace CT for metastatic disease as well. 

Study Design

  • In this prospective, non-inferiority study, 84 men with newly diagnosed metastatic testicular cancer were included.

  • For the pretreatment staging scan and first posttreatment evaluation scan, the patients underwent contrast-enhanced, thoracoabdominal CT and whole-body MRI including diffusion-weighted whole-body imaging with background body signal suppression.

  • Pretreatment MRI and CT were a median of 5 days apart whereas posttreatment MRI and CT were performed on the same day.

  • The authors compared the specificity and sensitivity of the two modalities.

Key Results

  • On the patient level, MRI had a sensitivity of 98% and a specificity of 75% for detecting metastases.

  • One MRI result was a false positive while two were false negatives.

  • On the lesion level, 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%).

  • Interobserver agreement was substantial between CT and MRI.

Limitations

  • Lesion diagnosis was not confirmed by pathology. Instead, CT was used as a reference or data from the pre- and post-treatment scans were used as a reference.

  • Knowledge of the diagnosis created a bias toward judging lesions as malignant and thus increasing sensitivity and decreasing specificity.

Disclosures

  • The study was funded by Aarhus University Hospital in Denmark.

  • The investigators had no disclosures.

This is a summary of a preprint research study, "Can Whole-body MRI Replace CT in Management of Metastatic Testicular Cancer? A Prospective, Non-inferiority Study," led by Solveig Kärk Abildtrup Larsen, MD, of Aarhus University Hospital, Denmark. The study has not been peer reviewed, and can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape. He is an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com

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