What is the benefit of gadolinium-chelate injection for the diagnosis of local recurrence of clear cell renal cell carcinoma after percutaneous thermal ablation with MRI? - 30/11/23
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Highlights |
• | Non contrast and contrast-enhanced MRI have good performances for discriminating between scars and recurrence after percutaneous thermal ablation of clear cell renal cell carcinoma. |
• | Non contrast and contrast-enhanced MRI have not significantly different performances for discriminating between scars and recurrence after percutaneous thermal ablation of clear cell renal carcinoma. |
• | Non contrast and contrast-enhanced MRI show no differences in inter-observer agreement for the diagnosis of recurrence after percutaneous thermal ablation of clear cell renal carcinoma. |
• | These results question the systematic use of gadolinium-based contrast agent-enhanced MRI for the follow-up of patients with clear cell renal cell carcinoma after percutaneous thermal ablation. |
Abstract |
Purpose |
The purpose of this study was to compare the diagnostic capabilities of contrast-enhanced (CE)-MRI to those of non-CE-MRI to diagnose local recurrence of clear cell renal cell carcinoma (ccRCC) after percutaneous thermal ablation (TA).
Materials and methods |
This institutional, review board-approved, case-control, single-center retrospective study included all consecutive adult patients with at least two post-TA MRIs showing local recurrence of ccRCC after TA validated by multidisciplinary board. ‘Control’ patients without recurrence were randomly-selected with a case:control ratio of 2/3. Four senior radiologists reviewed in a double-blinded fashion non-CE sequences of last two consecutive MRI examinations (non-CE-MRIs), assessed the presence of recurrence of ccRCC, then reviewed the CE sequences (CE-MRI) and determined again the presence of a recurrence. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity and accuracy were compared for each reader for non-CE-MRI and CE-MRI.
Results |
Fifty-one patients (41 men; mean age, 77.5 years) who underwent percutaneous TA for ccRCC were included. There were a total of 21 recurrences and 35 scars. Whoever the reader, AUROC was not significantly different (mean, 0.86 with-CE-MRI vs. 0.81 with non-CE-MRI; P values ranging between 0.08 and 0.98), neither sensitivity (mean, 76.2% with CE-MRI vs. 71.4% with non-CE-MRI; P values ranging between 0.06 and >0.99), nor accuracy (85.8% with CE-MRI vs. 80.8% with non-CE-MRI; P values ranging between 0.07 and >0.99). Change in specificity depended on the reader with a significant increase for one reader (+20%; P = 0.02) and a significant decrease for another reader (-17.2%; P = 0.03).
Conclusion |
Non-CE MRI has good diagnostic performance for the follow-up of patients with ccRCC treated using percutaneous TA, questioning the systematic use of GBCA injection.
Le texte complet de cet article est disponible en PDF.Index terms : Clear cell renal cell carcinoma, Contrast media, Cryosurgery, Magnetic resonance imaging, Radiofrequency ablation, Renal tumor
Abbreviations : AUROC, CI, ccRCC, CE, GBCA, LD, ROC, SD, TA
Plan
Vol 104 - N° 12
P. 584-593 - décembre 2023 Retour au numéro
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