Whole-body MRI in follow-up of patients with renal cell carcinoma.
BACKGROUND
Recent technological advances have made whole-body MRI feasible within a reasonable time-frame. The clinical utility of whole-body MRI in patients with renal cell carcinoma has not been evaluated yet.


OBJECTIVE
To compare the diagnostic accuracy of whole-body MRI and computed tomography (CT) in follow-up of patients with renal cell carcinoma.


METHODS
In 28 patients with primary renal cell carcinoma a multislice CT scan of the thorax, abdomen, and pelvis, and a whole-body MRI were carried out as part of the postoperative follow-up. A combination of subsequent imaging studies and histology served as standard of reference.


RESULTS
MRI demonstrated a significantly better diagnostic accuracy regarding musculoskeletal metastases compared with CT (97.7% vs 82%, P<0.001). In contrast, CT was superior in the detection of pulmonary metastases (88.5% vs 71.9%, P<0.001). Both methods had similar diagnostic performance regarding lymph node metastases (CT, accuracy 82.4%; MRI, accuracy 83.4%, P=0.25). The concordance of both modalities regarding N and M stage was excellent (Cohen's kappa 1.00). In two patients cerebral metastases were revealed by MRI, which led to a change in therapy.


CONCLUSIONS
At this stage, whole-body MRI cannot be considered an adequate replacement for CT in the follow-up of patients with renal cell carcinoma. Further significant improvement of lung MR protocols is necessary, as CT's sensitivity for pulmonary nodules is clearly superior. In contrast, the main advantage of whole-body MRI is its high diagnostic accuracy for musculoskeletal metastases.
Platzek
Ivan
I
Department of Radiology, Dresden University of Technology, Dresden, Germany. ivan.platzek@uniklinikum-dresden.de
Zastrow
Stefan
S
Deppe
Pierre-Emanuel
PE
Grimm
Marc-Oliver
MO
Wirth
Manfred
M
Laniado
Michael
M
Stroszczynski
Christian
C
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D019786:Gadolinium DTPA