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Whole‐body MRI with diffusion‐weighted sequences compared with 18 FDG PET‐CT, CT and superficial lymph node ultrasonography in the staging of advanced cutaneous melanoma: a prospective study
Author(s) -
Jouvet J.C.,
Thomas L.,
Thomson V.,
Yanes M.,
Journe C.,
Morelec I.,
Bracoud L.,
Durupt F.,
Giammarile F.,
Berthezene Y.
Publication year - 2014
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.12078
Subject(s) - medicine , radiology , lymph node , melanoma , ultrasonography , pet ct , nuclear medicine , prospective cohort study , diffusion mri , magnetic resonance imaging , computed tomography , pathology , cancer research
Objectives The aim of our study was to compare the diagnostic performances of non‐radiating whole‐body magnetic resonance imaging (wb MRI ), either volumetric, with Volumetric interpolated breath‐hold examination ( VIBE ) or metabolic, with diffusion‐weighted sequences (wb MRI ), with classical irradiating techniques such as PET ‐ CT , CT and with lymph node ultrasonography ( US ) for the staging of advanced melanoma. Patients and methods Thirty‐seven melanoma AJCC stage IV patients were prospectively included. All images were independently interpreted without prior knowledge of the results of studies performed with concurrent techniques, and all imaging techniques were scheduled within a mean interval of 7 days. The overall and site‐specific diagnosis performances of each imaging modality were studied, as well as the interest of combined MRI VIBE and diffusion sequences. Results The number of visceral or lymph node metastases spotted was, respectively, 218, with 125 metastases for wb MRI , 191/103 for PET ‐ CT , 209/115 for CT and 33/13 for lymph node US . No statistically significant difference ( P < 0.05) of overall diagnostic performances between wb MRI (Se 84%, Sp 87.1%, PPV 89.8%, NPV 80.2%) and PET ‐ CT (Se 79.8%, Sp 93.1%, PPV 93.2%, NPV 79.4%) was observed. No statistically significant difference was found between wb MRI and PET ‐ CT with two channels for CT with respect to different metastatic sites. Compared with the CT , wb MRI had significantly better overall specificity ( P = 0.0011) and PPV ( P = 0.02). For lung exploration, sensitivity of wb MRI (51.6%) was inferior to CT (71.4%). To detect superficial metastatic lymph nodes, wb MRI and US both showed high diagnostic accuracy with no statistically significant difference. Intra‐observer agreement was almost perfect for all imaging modalities considering the overall staging. Inter‐observer agreement for wb MRI and diffusion alone was almost perfect except for bone and lymphatic sites. Overall diagnostic performance of diffusion alone was significantly inferior to those of combined VIBE and diffusion sequences. Conclusions Whole‐body MRI , using diffusion weighted sequences, was a reliable non‐radiating imaging for staging of melanoma and offers the same diagnostic performances than combined CT , PET ‐ CT and lymph node US .