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MRI or CT during active surveillance?

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  • MRI or CT during active surveillance?

    Hi All,

    The last discussion on this forum about MRI versus CT during active surveillance is from 2011 (

    I am wondering if common practices have changed since then. Has anyone discussed the possibility of using MRIs instead of CT scans during post-orchiectomy active surveillance? The TRISST study that compares CT versus MRI and low-frequency versus high frequency imaging is still underway, and I don't think there are any result yet (

    In my own case, it's a Stage IA pure seminoma, mid-sized tumor (4.0cm, pT1), pre- and post-op markers were negative, post-op CT was negative. We decided to go with active surveillance and my doctor seems comfortable with recommending MRI instead of CT (assuming my insurance covers it). I'll have 3-month, 6-month and 12-month scans for the first year. On the one hand, I'm happy that I'm avoiding CT. On the other hand since my markers were negative even before pre-op, imaging seems like the only option to capture a relapse in time and that makes me a bit nervous.

    I would appreciate if you share your experiences if you considered MRIs, what your doctor recommended and what kind of specifications the scanner should have for reliable images in the case of TC.
    Last edited by confidentcoyote; 02-08-18, 09:43 PM.

  • #2
    Seems like the jury is still out on this, but most places I have heard about stick to CT.I have no idea if it's out of cost or accuracy of the images. I do believe the MRI takes longer, & ear plugs might be a good idea ( they are very noisy)..

    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP


    • #3
      Some countries, such as Sweden and Norway, do use MRI but this is also done in centralized locations that have experienced radiologists in using MRI to monitor for retroperitoneal disease. I have actually communicated with one of the TRISST physicians and at the time of the communication a few years ago, they do not use MRI outside of their trial.

      A review of clinical stage I testicular cancer relapse patterns was published a few years ago and the vast majority of seminoma patients that relapsed were detected via CT/MRI imaging of the abdomen. Interestingly, in this article these experts stated that, "MRI imaging should be restricted to centers with the necessary technical requirements (MRI abdomen protocol) and a high MRI experience."

      While MRI may be used to me the risk of the center missing or falsely identifying a relapse via MRI is a higher risk than the risk of any secondary malignancy risk due to radiation exposure from CT. This is assuming that your CT schedule is reasonable and that they are using dose controls to reduce the radiation exposure (low-dose CT). We also have a campaign about low-dose CT and things that you can do to try to reduce your exposure risk at that may be of interest.

      Oct. 2005 felt lump but waited over 7 months.
      06.15.06 "You have Cancer"
      06.26.06 Left I/O
      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
      06.30.06 It's Official - Stage I Seminoma
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary


      • #4
        Edited - What i read on UK Forum "CT scan for squishy bits, MRI for bony bits in my experience.
        PET CT scan is the gold standard scan for seminoma - it combines a PET scan and a CT scan, and they overlay one on the other. The CT scan shows what is there, the PET scan shows what its doing. A short half-life radioactive glucose solution is injected and any part of the body actively consuming glucose uses it up, so you sit very still and quiet for an hoour, and then have the scan. If any nodes have active cancer they glow on the picture.
        A CT scan is pretty safe, the odd one now and then makes little or no difference to your lifetime exposure."
        PS CT Scan of abdomen + pelvis ~ 1400mrem, the max allowed per international standard to people handling Nuclear products is 5000mrem / y so 3 CT Scans get you there)
        Last edited by lautreamont; 02-13-18, 01:21 PM.


        • #5
          I'm using MRIs.
          This was a major sticking point with my first oncologist, so I switched to one who is more flexible (and more experienced).
          The MRI's are definitely more expensive, take longer, and are even less pleasant than CT's. You may have trouble getting insurance to cover them.
          The jury is out about whether the MRI's have sufficient resolution of the retroperitoneal lymph nodes (hence the on-going TRISST study) to provide similarly valuable information about relapse at the earliest stages.

          If, like me, you are willing to swap a bit of uncertainty about resolution for the certainty of reduced radiation burden, MRI's may be an option, but you may need to shop around a bit to find an oncologist willing to work with you.

          Please note those of you who are quick to take offense of any deviation from standard protocols, that I am not advocating that MRI's are preferable for anyone, let alone everyone. I'm not even sure they are preferable for me. What I am advocating for is informed patients making informed decisions about trade-offs and acceptable levels of uncertainty with informed clinicians.
          Painless lump 5/18/2017
          Orchidectomy June 2017 (4.5cm, rete testis involvement)
          Chemo Summer 2017 (2x7AUC carboplatin)
          No evidence of relapse since, but plenty of anxiety about it.

          I'm also an epidemiologist, and a professor at a medical school (with NO training in oncology), oh, and gay, too.


          • #6
            I'm using MRIs. My urologist left it up to me. Not sure if it's a German thing or a specific-to-this-guy thing, but he said the increased accuracy of the CT (about twice the resolution, to oversimplify it) wasn't worth the trade-off of increased risk of secondary cancer from scan radiation. I argued for an MRI and he didn't need much pushing, said "That makes sense to me, as long as you understand the trade-off."
            JAN.2015- mild pain/swelling in RT, spread to abd., GP misdiagnosed as orchitis. (SEE A UROLOGIST, GUYS!)
            JUN27- Diagnosed
            JUN28- AFP ~250, bHCG ~90, LDH ~1.6x
            JUL01- Right orch.; 4x3 cm tumor, 90% EC, 10% yolk), CT shows 2.8cm met in abdom. + smallish mediastinum mets including one 7mm; staged III-A
            JUL06- 3xBEP start
            JUL07- AFP ~225, bHCG ~110, LDH ~2.3x, LDH qualifies as stage III-B, upped to 4xBEP
            JUL28- AFP ~25, bHCG ~15, LDH normal
            AUG17- AFP, bHCG, LDH normalized by 3rd cycle
            SEP21- 4xBEP done, no complications; a few +2cm masses remain in retroperitoneum
            DEC02- RPLND, necrosis + bit of mat. tera., retrograde
            JAN. 2016- Surveillance, exercise, working, SIGUE!
            NOV. 2017- Retrograde improves. Still not normal but better.
            FEB. 2018- 26 MONTHS ALL CLEAR.