MRI Could Replace CT for Detecting Metastatic Testicular Cancer

M. Alexander Otto, MMS, PA

January 14, 2022

This study, published on as a preprint and not yet peer reviewed, found no meaningful loss of sensitivity with MRI compared with CT, and utilizing the MRI eliminates radiation exposure.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


  • 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.


  • 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 The study has not been peer reviewed, and can be found at

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:

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