Jean-Christophe Jouvet, Presenter: Nothing to Disclose

Loic Boussel MD, Abstract Co-Author: Nothing to Disclose

Yves Berthezene MD, PhD, Abstract Co-Author: Nothing to Disclose

Vivien Thomson MD, Abstract Co-Author: Nothing to Disclose

Luc Thomas, Abstract Co-Author: Nothing to Disclose

The aim of our study was to compare the diagnostic accuracy of non-radiating whole body MRI (wbMRI) with VIBE (Volumetric Interpolated Breath-hold Examination) and diffusion weighted sequences, PET-CT, contrast-enhanced CT, lymph node ultrasonography (US) for the staging of advanced melanoma.

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. The overall and site-specific diagnosis performances of each imaging modality was studied compared to the standard of reference established either by histopathology or by sequential imaging during clinical follow-up. The interest of combined MRI VIBE and diffusion sequences was also studied.  

The number of visceral or lymph node metastases detected was respectively of 218 corresponding to 125 metastases for wbMRI, 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 wbMRI (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%) were observed. No statistically significant difference was found between wbMRI and PET-CT with respect to different metastatic sites. Compared to the CT, wbMRI had significantly better overall specificity (p=0.0011) and PPV (p=0.02). For lung exploration, sensitivity of wbMRI (51,6 %) was inferior to CT (71,4%). To detect superficial metastatic lymph nodes, wbMRI (Se 100%, Sp 95%, PPV 92,8%, NPV 100%) and US(Se 100%, Sp 100%, PPV 100%, NPV 100%) both showed high diagnostic accuracy with no statistically significant difference.

Whole body MRI, using diffusion weighted sequences, is a reliable non-radiating imaging for staging of melanoma and offers the same diagnostic performances than combined CT, PET-CT and lymph node US.

In the case of advanced melanoma, an exhaustive estimation of the metastatic spread, providing by whole body MRI, is essential in order to choose the best therapeutic approach: surgical or palliative

Jouvet, J, Boussel, L, Berthezene, Y, Thomson, V, Thomas, L, 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.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028560.html