Abstract
Whole-Body Magnetic Resonance Imaging (WB-MRI) is increasingly used for metastatic screening in oncology. This prospective single center study assesses the diagnostic value of WB-MRI including diffusion weighted imaging (DWI) and identifies the sufficient protocol for metastatic lymph node detection in patients with testicular germ cell cancer (TGCC). Forty-three patients underwent contrast enhanced thoraco-abdominopelvic CT (TAP-CT) and WB-MRI with DWI for metastatic lymph node screening. Two independent readers reviewed CTs and WB-MRIs. The diagnostic performance of different imaging protocols (CT, complete WB-MRI, T1W + DWI, T2W + DWI), the agreement between these protocols and the reference standard, the reproducibility of findings and the image quality (Signal and contrast to Noise Ratios, Likert scale) were studied. Reproducibility was very good regardless of both lesion locations (retroperitoneal vs distant lymph nodes, other lesions) and the reader. Diagnostic accuracy of MRI was ≥95% (regardless of the locations and imaging protocol); accuracy of CT was ≥93%. There was a strict overlap of 95% CIs associated with this accuracy between complete WB-MRI, T1W + DWI and T2W + DWI, regardless of the reader. Higher Likert score and SNR were observed for DWI, followed by T2W and T1W sequences. In conclusion, a fast WB-MRI protocol including T2W and DWI is a sufficient, accurate, non-irradiating alternative to TAP-CT for metastatic lymph node screening in TGCC.
Highlights
testicular germ cell cancer (TGCC) typically metastasize in a predictable way, via lymphatic drainage and retroperitoneal lymph nodes (RPLN) are the most common sites for metastatic disease [2,3,4]
Concerning the metastatic lymph nodes, 28 RPLN were detected with median size value = 21 mm [18 mm; 28 mm] and distant lymph nodes (DLN) with median size value = mm
* Mean effective dose per computed tomography (CT) = 5.1 mSv; ** Mean effective dose per Chest X-ray = 0.0005 mSv; Abbreviations: mSv: millisievert, LVI: Lymphovascular invasion. This prospective study assessed the performance of Whole-Body Magnetic Resonance Imaging (WB-Magnetic resonance imaging (MRI)) for the detection of lymph node metastases in patients with TGCC. total WB-MRI including diffusion weighted imaging (DWI) + axial T2 weighted sequence (T2W)
Summary
Testicular germ cell cancer (TGCC) account for 1–3% of all cancers in men, being most common in the age group 15 to 35 years and considered curable in more than 90% of cases [1,2]. TGCCs typically metastasize in a predictable way, via lymphatic drainage and retroperitoneal lymph nodes (RPLN) are the most common sites for metastatic disease [2,3,4]. Proper staging and follow-up of testicular cancer patients is essential for planning the treatment and avoiding unnecessary interventions. 70–80% of seminomas and one third of NSGCC have clinical stage I disease at diagnosis (there is no evidence of spread to either lymph nodes or other organs) [5,6]. Because of the potential harmful effects of irradiation in these young men, the follow-up must be planned carefully by keeping radiation doses “as low as reasonably achievable” and some new protocols include low-dose computed tomography (CT) examinations [8]
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