Benefits of MRI Versus Dual-Energy CT in Local-Regional Staging for Patients With Gastric Cancer

In patients with gastric cancer (GC), preoperative local-regional tumor staging is an important step in the creation of an accurate treatment plan. Currently, there is little research on the comparative accuracy of multiparametric magnetic resonance imaging (mpMRI) versus dual-energy computed tomography (DECT) for the staging of GC.

Research from Qiong Li, PhD, and colleagues published in Radiology sought to compare the diagnostic accuracy of personalized mpMRI with DECT in the local-regional staging of patients with GC who underwent curative surgical intervention.

The study included 202 patients with GC who received gastric mpMRI and DECT prior to gastrectomy with lymphadenectomy between November 2021 and September 2022.

For head-to-head accuracy comparisons between mpMRI and DECT, Dr. Li and colleagues conducted the McNemar test. mpMRI included T2-weighted imaging, multi-orientational zoomed diffusion-weighted imaging, and extradimensional volumetric interpolated breath-hold examination dynamic contrast-enhanced imaging. Researchers reconstructed dual-phase DECT images at 40 keV and standard 120 kVp-like images.

Gastrectomy specimens were used as the reference standard, with 6 radiologists comparing the diagnostic accuracy of mpMRI and DECT for T and N staging in a pairwise blinded manner.

For T and N staging, the interreader agreement of the 6 readers was “excellent” for both mpMRI (κ=0.89 and κ=0.85, respectively) and DECT (κ=0.86 and κ=0.84, respectively). Dr. Li and colleagues noted that use of mpMRI led to higher accuracy for both T and N staging, especially in T1 (83% vs 65%) and T4a (78% vs 68%) tumors and N1 (41% vs 24%) and N3 (64% vs 45%) nodules (all P<.05).

“Personalized mpMRI was superior in T staging and noninferior or superior in N staging compared with DECT for patients with GC,” the researchers wrote.