Whole body MR imaging: Applications in oncology

doi:10.1016/j.ejso.2005.09.018

European Journal of Surgical Oncology (EJSO)

Volume 32, Issue 3, April 2006, Pages 239-246

https://doi.org/10.1016/j.ejso.2005.09.018 Get rights and content

Abstract

This article reviews technique and clinical applications of whole body MR imaging as a diagnostic tool in cancer staging. In particular the article reviews its role as an alternative to scintigraphy (bone scan and PET) in staging skeletal spread of disease, its role in assessing total tumour burden, its role in multiple myeloma and finally its evolving non oncologic role predominantly assessing total body composition.

Introduction

Accurate diagnosis and staging of cancer is imperative to optimise treatment strategies with the ultimate goal of improved long term survival and possible cure. Cognoscente of the hazards of repeated ionizing radiation examinations, notably CT, interest has become focused on the potential use of whole body MRI techniques to stage and follow up oncologic disease.¹

Section snippets

Background

Whole body imaging can be afforded by radiographic skeletal survey, whole body CT, scintigraphy and more recently by positron emission tomography (PET). Each technique has advantages and disadvantages, choice often being made on the basis of availability, cost, sensitivity, specificity, radiation dose and acquisition time. Ideally, the imaging modality chosen should have both high sensitivity and specificity, but often a compromise must be made. Therefore, if one imaging strategy is minimally

Technique

The combination of moving tabletop, tabletop extender and image melding software now facilitates practical whole body imaging in three planes in less than 15 min.⁵

Turbo spin echo images with inversion recovery pulses are performed using a body coil. Pathology normally appears as high signal intensity foci. The inversion recovery component nulls the signal from fat (which normally also has a high signal intensity) and in doing so enhances the conspicuity of those lesions surrounded by fat, such

Applications

Whole body turboSTIR MRI has been employed in the evaluation of metastatic disease particularly to bone,⁷ lymphoma⁸ and myeloma. Non-oncologic applications include assessment of multifocal muscle disease, total body fat stores and whole body MR angiography to estimate atherosclerotic burden.

Conclusion

Recent advances in MR imaging, particularly the development of fast imaging techniques, have markedly reduced imaging time without compromising image quality. This has made feasible the clinical introduction of whole body MRI as a practical diagnostic tool. Whole body MRI is a valid, non-ionising and, in our experience, sensitive clinical tool. The technique will likely have its greatest impact in the evaluation of patients with suspected bone marrow or skeletal involvement by either metastases

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Cited by (38)

Multiparametric Whole-body MRI with Diffusion-weighted Imaging and ADC Mapping for the Identification of Visceral and Osseous Metastases From Solid Tumors
2018, Academic Radiology
The purpose of this study was to investigate the use of multiparametric, whole-body, diffusion-weighted imaging (WB-DWI) and apparent diffusion coefficient (ADC) maps with T₂-weighted magnetic resonance imaging (MRI) at 3T for the detection and monitoring of metastatic disease in patients.
Fifty-four participants (32 healthy subjects and 22 patients) were scanned with WB-DWI methods using a 3T MRI scanner. Axial, sagittal, or coronal fat-suppressed T₂-weighted (T₂WI), T₁-weighted (T₁WI), and DWI images were acquired. Total MRI acquisition and set-up time was approximately 45 minutes. Metastatic disease on MRI was confirmed based on T₂WI characteristics. The number of lesions was established on computed tomography (CT) or positron emission tomography (PET-CT). Whole-body ADC maps and T₂WI were constructed, and region-of-interests were drawn in normal and abnormal-appearing tissue for quantitative analysis. Statistical analysis was performed using a paired t tests and P < .05 was considered statistically significant.
There were 91 metastatic lesions detected from the CT or PET-CT with a missed recurrent lesion in the prostate. Multiparametric WB-MRI had excellent sensitivity (96%) for detection of metastatic lesions compared to CT. ADC map values and the ADC ratio in metastatic bone lesions were significantly increased (P < .05) compared to normal bone. In soft tissue, ADC map values and ratios in metastatic lesions were decreased compared to normal soft tissue.
We have demonstrated that multiparametric WB-MRI is feasible for oncologic staging to identify bony and visceral metastasis in breast, prostate, pancreatic, and colorectal cancers. WB-MRI can be tailored to fit the patient, such that an “individualized patient sequence” can be developed for a comprehensive evaluation for staging and response during treatment.
Whole body MRI in paediatric oncology
2014, Diagnostic and Interventional Imaging
Citation Excerpt :
The most important clinical application of WB-MRI in children, as in adults, is the screening of the metastatic spread of cancer. In most of the series published, MRI discovers more lesions than the so-called conventional techniques, and in particular, more than the examinations in nuclear medicine with which they are in direct competition [25–27]. Lymphoma is the third most common malignancy in the child, after leukaemia and brain tumours.
Whole body MRI provides excellent contrast resolution imaging and is an interesting alternative to nuclear medicine examinations in paediatric oncology because it does not involve exposure to radiation. This technique, now feasible in clinical practice, helps to evaluate metastatic spread and response to treatment, which are of great prognostic interest. Numerous studies have demonstrated the non-inferiority of this technique when compared to nuclear medicine examinations. However, there is still a need to standardize indications in each type of cancer and at every stage of it. This article first discusses the technical principles of whole body MRI, then reviews current clinical applications for the modality in children, and finally, discusses future useful developments for paediatric oncology.
Comparison of whole-body MRI and skeletal scintigraphy for detection of bone metastatic tumors: A meta-analysis
2013, Surgical Oncology
Citation Excerpt :
Moreover, osteoarthritis, fractures, and degenerative changes may lead to a high false-positive rate and decrease the specificity of skeletal scintigraphy. Whole-body magnetic resonance imaging (MRI) has become feasible with recent developments in MRI, including fast image acquisition, hardware innovation such as tabletop extenders, and the implementation of dedicated software [6]. This imaging modality has been shown to be of greater sensitivity and comparable specificity compared to bone scintigraphy in the detection of skeletal metastases [7–10].
We performed a meta-analysis to investigate and compare diagnostic performance of whole-body MRI and skeletal scintigraphy for detection of bone metastatic tumors.
PubMed and Embase were searched for relevant articles. We calculated sensitivities, specificities, diagnostic odds ratios (DOR), positive likelihood ratios (PLR), negative likelihood ratios (NLR), and constructed summary receiver operating characteristic curves using bivariate models for whole-body MRI and skeletal scintigraphy, respectively.
Across 7 studies (332 patients), whole-body MRI have similar patient-based sensitivity (0.84 vs 0.83), specificity (0.96 vs 0.94), DOR (137.0 vs 70.2), PLR (23.3 vs 13.0) and NLR (0.17 vs 0.19) with skeletal scintigraphy. Area under curves for whole-body MRI and skeletal scintigraphy was 0.94 and 0.89, respectively.
Both whole-body MRI and skeletal scintigraphy have good diagnostic performance for detecting bone metastatic tumors. It remains inconclusive whether whole-body MRI or bone scintigraphy is superior in detecting bone metastatic tumors.
Imaging of Lymphoma of the Musculoskeletal System
2010, Magnetic Resonance Imaging Clinics of North America
Whole-body MRI in the pediatric patient
2009, European Journal of Radiology
Citation Excerpt :
Overall, a WBMRI scan in our department is scheduled with 70 min. Oncological staging, with a focus on the detection of pathological signals, was the major stimulus for the development and use of WBMRI, primarily in adults [8–10]. In children and adolescents the technique was used in some initial studies, and up to now only in a limited number of patients was systematically evaluated.
Whole-body MRI is a fast and accurate modality for detection and monitoring of disease throughout the entire body. For pediatric use the technique is of special interest twofold: first it is a radiological method without radiation exposure and second it allows for whole-body staging as well as for detailed local evaluation for surgical treatment thus reducing the number of examinations to be performed in sedation. In the pediatric population the technique is used for oncological, non-oncological (i.e. fever of unknown origin, osteonecrosis) staging and for disease severity assessment of syndromes affecting the whole body. These applications will be reviewed and imaging protocols will be presented.
Whole-Body Diffusion-Weighted and Proton Imaging: A Review of This Emerging Technology for Monitoring Metastatic Cancer
2009, Seminars in Roentgenology
Citation Excerpt :
Similar results were found by Antoch et al,86 where the authors reported a diagnostic accuracy of 93% for whole-body MRI, compared to a diagnostic accuracy of 94% for PET-CT for assessment of the M-stage in the tumor nodal metastasis staging criteria.41 Moreover, others have reported high sensitivities using WB-MR, ranging from 71% to 95%.17,28,29,31,32,36,39-44,85,87,88 The ability to obtain high spatial resolution and “functional” images of the whole body for assessment of pathological disorders is of major importance to the oncologist, radiologist, and, more importantly, the patient.

View all citing articles on Scopus

^†: Cappagh National Orthopaedic Hospital is a clinical sciences research site for Philips Medical Systems, Best Holland.

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ReviewWhole body MR imaging: Applications in oncology

Abstract

Introduction

Section snippets

Background

Technique

Applications

Conclusion

JAMA

Whole body dual modality PET/CT and whole-body MRI for tumor staging in oncology

JAMA

Total body MR imaging in as little as 18 seconds

Radiology

Whole body MR imaging in 30 seconds with real time FISP and a continuously rolling table platform: feasibility study

Radiology

Three dimensional volumetric interpolated breath hold MR imaging for whole body tumor staging in less than 15 minutes: a feasibility study

AJR

Whole body short tau inversion recovery MR imaging using a moving table top

AJR

A comparison of whole-body turbo short tau inversion recovery MR imaging and planar technetium 99m methylene diphosphonate scintigraphy in the evaluation of patients with suspected skeletal metastases

Am J Roentgenol

Detection of bone marrow and extramedullary involvement in patients with non-Hodgkin's lymphoma by whole-body MRI: comparison with bone and 67Ga scintigraphies

Eur Radiol

Whole-body bone marrow MRI in patients with metastatic disease to the skeletal system

J Comput Assist Tomogr

Whole body MRI using a rolling table platform for the detection of bone metastases

Eur Radiol

Whole body TurboSTIR MR imaging in breast carcinoma: preliminary clinical experience

J Magn Reson Imaging

Review
Whole body MR imaging: Applications in oncology