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Lecouvet FE, Chabot C, Taihi L, Kirchgesner T, Triqueneaux P, Malghem J. Present and future of whole-body MRI in metastatic disease and myeloma: how and why you will do it. Skeletal Radiol 2024; 53:1815-1831. [PMID: 39007948 PMCID: PMC11303436 DOI: 10.1007/s00256-024-04723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
Metastatic disease and myeloma present unique diagnostic challenges due to their multifocal nature. Accurate detection and staging are critical for determining appropriate treatment. Bone scintigraphy, skeletal radiographs and CT have long been the mainstay for the assessment of these diseases, but have limitations, including reduced sensitivity and radiation exposure. Whole-body MRI has emerged as a highly sensitive and radiation-free alternative imaging modality. Initially developed for skeletal screening, it has extended tumor screening to all organs, providing morphological and physiological information on tumor tissue. Along with PET/CT, whole-body MRI is now accepted for staging and response assessment in many malignancies. It is the first choice in an ever increasing number of cancers (such as myeloma, lobular breast cancer, advanced prostate cancer, myxoid liposarcoma, bone sarcoma, …). It has also been validated as the method of choice for cancer screening in patients with a predisposition to cancer and for staging cancers observed during pregnancy. The current and future challenges for WB-MRI are its availability facing this number of indications, and its acceptance by patients, radiologists and health authorities. Guidelines have been developed to optimize image acquisition and reading, assessment of lesion response to treatment, and to adapt examination designs to specific cancers. The implementation of 3D acquisition, Dixon method, and deep learning-based image optimization further improve the diagnostic performance of the technique and reduce examination durations. Whole-body MRI screening is feasible in less than 30 min. This article reviews validated indications, recent developments, growing acceptance, and future perspectives of whole-body MRI.
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Affiliation(s)
- Frederic E Lecouvet
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
| | - Caroline Chabot
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Lokmane Taihi
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Thomas Kirchgesner
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Perrine Triqueneaux
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
| | - Jacques Malghem
- Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Institut du Cancer Roi Albert II, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, B-1200, Brussels, Belgium
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Zugni F, Mariani L, Lambregts DMJ, Maggioni R, Summers PE, Granata V, Pecchi A, Di Costanzo G, De Muzio F, Cardobi N, Giovagnoni A, Petralia G. Whole-body MRI in oncology: acquisition protocols, current guidelines, and beyond. LA RADIOLOGIA MEDICA 2024; 129:1352-1368. [PMID: 38990426 DOI: 10.1007/s11547-024-01851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Acknowledging the increasing use of whole-body magnetic resonance imaging (WB-MRI) in the oncological setting, we conducted a narrative review focusing on practical aspects of the examination and providing a synthesis of various acquisition protocols described in the literature. Firstly, we addressed the topic of patient preparation, emphasizing methods to enhance examination acceptance. This included strategies for reducing anxiety and patient distress, improving staff-patient interactions, and increasing overall patient comfort. Secondly, we analysed WB-MRI acquisition protocols recommended in existing imaging guidelines, such as MET-RADS-P, MY-RADS, and ONCO-RADS, and provided an overview of acquisition protocols reported in the literature regarding other expanding applications of WB-MRI in oncology, in patients with breast cancer, ovarian cancer, melanoma, colorectal and lung cancer, lymphoma, and cancers of unknown primary. Finally, we suggested possible acquisition parameters for whole-body images across MR systems from three different vendors.
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Affiliation(s)
- Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Leonardo Mariani
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Roberta Maggioni
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paul E Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori Di Napoli, IRCCS "G. Pascale", Naples, Italy
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Federica De Muzio
- Department of Radiology, Pineta Grande Hospital, Via Domitiana Km 30, Castel Volturno, Italy
| | - Nicolò Cardobi
- Radiology Unit, Department of Pathology and Diagnostics, University Hospital of Verona, Verona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria Delle Marche", Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Giuseppe Petralia
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Mori H, Wakabayashi H, Saito S, Nakajima K, Yoshida K, Hiromasa T, Kinuya S. Evaluating the diagnostic efficacy of whole-body MRI versus 123I-mIBG/ 131I-mIBG imaging in metastatic pheochromocytoma and paraganglioma. Sci Rep 2024; 14:13828. [PMID: 38879654 PMCID: PMC11180102 DOI: 10.1038/s41598-024-64607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
This study aimed to compare tumor lesion detectability and diagnostic accuracy of whole-body magnetic resonance imaging (WB-MRI) and radioiodine-labeled meta-iodo-benzylguanidine (mIBG) imaging techniques in patients with metastatic pheochromocytoma and paraganglioma (PPGL). This retrospective study included 13 patients had pheochromocytoma and 5 had paraganglioma, who were all suspected of having metastatic tumors. Each patient underwent WB-MRI and 123I-mIBG as a pretreatment screening for 131I-mIBG therapy. Two expert reviewers evaluated WB-MRI, 123I-mIBG images, and post-therapy 131I-mIBG images for the presence of metastatic lesions in the lungs, bones, liver, lymph nodes, and other organs. Diagnostic measures for detecting metastatic lesions, including sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC)-area under the curve (AUC), were calculated for each imaging technique. We analyzed WB-MRI images for detecting metastatic lesions, which demonstrated sensitivity, specificity, accuracy, PPV, NPV, and AUC of 82%, 97%, 90%, 96%, 86%, and 0.92, respectively. These values were 83%, 95%, 89%, 94%, 86%, and 0.90 in 123I-mIBG images and 85%, 92%, 89%, 91%, 87%, and 0.91 in post-therapy 131I-mIBG images, respectively. Our results reveal the comparable diagnostic accuracy of WB-MRI to one of the mIBG images.
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Affiliation(s)
- Hiroshi Mori
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shintaro Saito
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kotaro Yoshida
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Tomo Hiromasa
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Krishan R, Pandey S, Sakhuja P, Goyal S, Bhardwaj K, Vageesh BG, Agarwal AK. Primary Hepatic Melanoma: A Diagnostic Surprise. Int J Surg Pathol 2024:10668969241236858. [PMID: 38567400 DOI: 10.1177/10668969241236858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Melanoma is a relatively rare malignancy with a highly aggressive biological behavior. Metastases to other sites, like lymph nodes and liver are common, but primary hepatic melanoma is a rarity with poor survival ranging from months to few years. Diagnosis of primary hepatic melanoma via clinical features and imaging technology is difficult because of its ambiguous features. Here, we present a 26-year-old North Indian woman admitted in the department of gastrointestinal surgery at our tertiary care hospital with the complaint of pain in the abdomen for a month associated with the loss of appetite and subsequent weight loss. The liver function tests were within normal limits and viral markers were negative. The triple-phase computed tomography scan of abdomen showed significant hepatomegaly and two well-defined lesions in both lobes of the liver. Histopathological evaluation was performed on the core liver biopsies submitted from the liver lesions. A malignant tumor with abundant black intracytoplasmic pigment was identified. Immunohistochemistry proved the tumor to be melanoma. The detailed clinical history, laboratory, and radiological investigations were acquired and analyzed to rule out a metastatic lesion of the same. A final diagnosis of primary hepatic melanoma was thus rendered. Primary hepatic melanoma is extremely uncommon and has been rarely reported. Preoperative diagnosis is challenging due to low index of suspicion and nonspecific clinical features. In this case report, we discuss the clinicopathological features of primary hepatic melanoma and review the literature so as to increase the awareness and improve our understanding of the disease.
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Affiliation(s)
- Ram Krishan
- Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sachita Pandey
- Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Puja Sakhuja
- Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Surbhi Goyal
- Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Krishna Bhardwaj
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, GIPMER, New Delhi, India
| | - B G Vageesh
- Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, GIPMER, New Delhi, India
| | - Anil K Agarwal
- Department of GI Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, GIPMER, New Delhi, India
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Rossi A, Prochowski Iamurri A, Diano D, Oboldi D, Sintuzzi E, Maurizio L, Andalò A, Cavallucci M, Ferroni F, Amadori E, Barone D, Petralia G. Patient centered radiology: investigating 3 Tesla whole body MRI acceptance in cancer patients. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01665-y. [PMID: 37395842 DOI: 10.1007/s11547-023-01665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Whole body magnetic resonance imaging (WB-MRI) is a promising emerging imaging technology for detecting bone and soft tissue pathology, especially in the onco-hematological field. This study aims to evaluate cancer patients' experience of WB-MRI performed on a 3T scanner compared to other diagnostic total body examinations. MATERIAL AND METHOD In this prospective committee-approved study, patients completed a questionnaire in person (n = 134) after undergoing a WB-MRI scan to collect data on their physical and psychological reactions during the scan, the global satisfaction level, and preference for other types of MRI or computed tomography (CT), or positron emission tomography (PET/CT). Of all patients who had performed a CT or PET/CT the previous year, 61.9% had already undergone an MRI. The most common symptoms reported were: 38.1% perceived a localized increase in temperature and 34.4% numbness and tingling of the limbs. The scan time averaged 45 min and was well tolerated by most patients (112, 85.5%). Overall, WB-MRI was appreciated by the majority (121/134-90.3%) of patients who said they would probably undergo the procedure again. Patients preferred the WB-MRI in 68.7% of cases (92/134), followed by CT in 15.7% of cases (21/134) and by PET/CT in 7.4% (10/134), with 8.4% (11/134) of patients without any preference. The preference for imaging modalities was age-dependent (p = 0.011), while (p > 0.05) was independent of sex and a primary cancer site. CONCLUSION These results demonstrate a high degree of WB-MRI acceptance from a patient's point of view.
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Affiliation(s)
- Alice Rossi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Andrea Prochowski Iamurri
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
| | - Danila Diano
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Devil Oboldi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Emanuele Sintuzzi
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Laghi Maurizio
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alice Andalò
- Data Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Martina Cavallucci
- Data Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Fabio Ferroni
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Elena Amadori
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Domenico Barone
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
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Reinert CP, Liang C, Weissinger M, Vogel J, Forschner A, Nikolaou K, la Fougère C, Seith F. Whole-Body Magnetic Resonance Imaging (MRI) for Staging Melanoma Patients in Direct Comparison to Computed Tomography (CT): Results from a Prospective Positron Emission Tomography (PET)/CT and PET/MRI Study. Diagnostics (Basel) 2023; 13:diagnostics13111963. [PMID: 37296815 DOI: 10.3390/diagnostics13111963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE The consideration of radiation exposure is becoming more important in metastatic melanoma due to improved prognoses. The aim of this prospective study was to investigate the diagnostic performance of whole-body (WB) magnetic resonance imaging (MRI) in comparison to computed tomography (CT) with 18F-FDG positron emission tomography (PET)/CT and 18F-PET/MRI together with a follow-up as the reference standard. METHODS Between April 2014 and April 2018, a total of 57 patients (25 females, mean age of 64 ± 12 years) underwent WB-PET/CT and WB-PET/MRI on the same day. The CT and MRI scans were independently evaluated by two radiologists who were blinded to the patients' information. The reference standard was evaluated by two nuclear medicine specialists. The findings were categorized into different regions: lymph nodes/soft tissue (I), lungs (II), abdomen/pelvis (III), and bone (IV). A comparative analysis was conducted for all the documented findings. Inter-reader reliability was assessed using Bland-Altman procedures, and McNemar's test was utilized to determine the differences between the readers and the methods. RESULTS Out of the 57 patients, 50 were diagnosed with metastases in two or more regions, with the majority being found in region I. The accuracies of CT and MRI did not show significant differences, except in region II where CT detected more metastases compared to MRI (0.90 vs. 0.68, p = 0.008). On the other hand, MRI had a higher detection rate in region IV compared to CT (0.89 vs. 0.61, p > 0.05). The level of agreement between the readers varied depending on the number of metastases and the specific region, with the highest agreement observed in region III and the lowest observed in region I. CONCLUSIONS In patients with advanced melanoma, WB-MRI has the potential to serve as an alternative to CT with comparable diagnostic accuracy and confidence across most regions. The observed limited sensitivity for the detection of pulmonary lesions might be improved through dedicated lung imaging sequences.
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Affiliation(s)
- Christian Philipp Reinert
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Cecilia Liang
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Matthias Weissinger
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Jonas Vogel
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Liebermeisterstrasse 25, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Christian la Fougère
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Ferdinand Seith
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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Martín-Noguerol T, Casado-Verdugo OL, Beltrán LS, Aguilar G, Luna A. Role of advanced MRI techniques for sacroiliitis assessment and quantification. Eur J Radiol 2023; 163:110793. [PMID: 37018900 DOI: 10.1016/j.ejrad.2023.110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
The introduction of MRI was supposed to be a qualitative leap for the evaluation of Sacroiliac Joint (SIJ) in patients with Axial Spondyloarthropathies (AS). In fact, MRI findings such as bone marrow edema around the SIJ has been incorporated into the Assessment in SpondyloArthritis International Society (ASAS criteria). However, in the era of functional imaging, a qualitative approach to SIJ by means of conventional MRI seems insufficient. Advanced MRI sequences, which have successfully been applied in other anatomical areas, are demonstrating their potential utility for a more precise assessment of SIJ. Dixon sequences, T2-mapping, Diffusion Weighted Imaging or DCE-MRI can be properly acquired in the SIJ with promising and robust results. The main advantage of these sequences resides in their capability to provide quantifiable parameters that can be used for diagnosis of AS, surveillance or treatment follow-up. Further studies are needed to determine if these parameters can also be integrated into ASAS criteria for reaching a more precise classification of AS based not only on visual assessment of SIJ but also on measurable data.
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Affiliation(s)
| | - Oscar L Casado-Verdugo
- Osatek Alta Tecnología Sanitaria S.A., Department of Magnetic Resonance Imaging, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Luis S Beltrán
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Jaén, Spain
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Diaz MJ, Mark I, Rodriguez D, Gelman B, Tran JT, Kleinberg G, Levin A, Beneke A, Root KT, Tran AXV, Lucke-Wold B. Melanoma Brain Metastases: A Systematic Review of Opportunities for Earlier Detection, Diagnosis, and Treatment. Life (Basel) 2023; 13:life13030828. [PMID: 36983983 PMCID: PMC10053844 DOI: 10.3390/life13030828] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/25/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction: Melanoma continues to represent the most serious skin cancer worldwide. However, few attempts have been made to connect the body of research on advanced melanoma. In the present review, we report on strides made in the diagnosis and treatment of intracranial metastatic melanoma. Methods: Relevant Cochrane reviews and randomized-controlled trials published by November 2022 were systematically retrieved from the Cochrane Library, EMBASE, and PubMed databases (N = 27). Search and screening methods adhered to the 2020 revision of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results: Although the research surrounding the earlier detection of melanoma brain metastasis is scarce, several studies have highlighted specific markers associated with MBM. Such factors include elevated BRAFV600 mutant ctDNA, high LDH concentration, and high IGF-1R. The approach to treating MBM is moving away from surgery and toward nonsurgical management, namely, a combination of stereotactic radiosurgery (SRS) and immunotherapeutic agents. There is an abundance of emerging research seeking to identify and improve both novel and established treatment options and diagnostic approaches for MBM, however, more research is still needed to maximize the clinical efficacy, especially for new immunotherapeutics. Conclusions: Early detection is optimal for the efficacy of treatment and MBM prognosis. Current treatment utilizes chemotherapies and targeted therapies. Emerging approaches emphasize biomarkers and joint treatments. Further exploration toward preliminary identification, the timing of therapies, and methods to ameliorate adverse treatment effects are needed to advance MBM patient care.
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Affiliation(s)
| | - Isabella Mark
- College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Daphnee Rodriguez
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Beata Gelman
- Department of Biology, University of Maryland, College Park, MD 20742, USA
| | - Jasmine Thuy Tran
- School of Medicine, University of Indiana, Indianapolis, IN 46202, USA
| | - Giona Kleinberg
- College of Engineering, Northeastern University, Boston, MA 02115, USA
| | - Anna Levin
- School of Arts and Sciences, Rutgers University, Piscataway, NJ 08854, USA
| | - Alice Beneke
- College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Kevin Thomas Root
- College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Andrew Xuan Vinh Tran
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
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Carter TJ, George C, Harwood C, Nathan P. Melanoma in pregnancy: Diagnosis and management in early-stage and advanced disease. Eur J Cancer 2022; 166:240-253. [PMID: 35325701 DOI: 10.1016/j.ejca.2022.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
Approximately one-third of women diagnosed with melanoma are of child-bearing age. The annual incidence of melanoma has risen steadily over the last 40 years, resulting in increasing numbers of women diagnosed with melanoma both during pregnancy, and post-partum. To date, there are no formal guidelines on the management of pregnancy associated melanoma (PAM), both early stage and metastatic. This article reviews the existing literature and provides a framework for the investigation and multidisciplinary management of PAM.
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Affiliation(s)
- Thomas J Carter
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Christina George
- Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - Paul Nathan
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, UK.
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Clinical Evaluation of an Abbreviated Contrast-Enhanced Whole-Body MRI for Oncologic Follow-Up Imaging. Diagnostics (Basel) 2021; 11:diagnostics11122368. [PMID: 34943604 PMCID: PMC8700680 DOI: 10.3390/diagnostics11122368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022] Open
Abstract
Over the last decades, overall survival for most cancer types has increased due to earlier diagnosis and more effective treatments. Simultaneously, whole-body MRI-(WB-MRI) has gained importance as a radiation free staging alternative to computed tomography. The aim of this study was to evaluate the diagnostic confidence and reproducibility of a novel abbreviated 20-min WB-MRI for oncologic follow-up imaging in patients with melanoma. In total, 24 patients with melanoma were retrospectively included in this institutional review board-approved study. All patients underwent three consecutive staging examinations via WB-MRI in a clinical 3 T MR scanner with an abbreviated 20-min protocol. Three radiologists independently evaluated the images in a blinded, random order regarding image quality (overall image quality, organ-based image quality, sharpness, noise, and artifacts) and regarding its diagnostic confidence on a 5-point-Likert-Scale (5 = excellent). Inter-reader agreement and reproducibility were assessed. Overall image quality and diagnostic confidence were rated to be excellent (median 5, interquartile range [IQR] 5–5). The sharpness of anatomic structures, and the extent of noise and artifacts, as well as the assessment of lymph nodes, liver, bone, and the cutaneous system were rated to be excellent (median 5, IQR 4–5). The image quality of the lung was rated to be good (median 4, IQR 4–5). Therefore, our study demonstrated that the novel accelerated 20-min WB-MRI protocol is feasible, providing high image quality and diagnostic confidence with reliable reproducibility for oncologic follow-up imaging.
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11
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Radbruch A, Paech D, Gassenmaier S, Luetkens J, Isaak A, Herrmann J, Othman A, Schäfer J, Nikolaou K. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 2. Invest Radiol 2021; 56:692-704. [PMID: 34417406 DOI: 10.1097/rli.0000000000000818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.
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Affiliation(s)
- Alexander Radbruch
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Daniel Paech
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Sebastian Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Julian Luetkens
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alexander Isaak
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Judith Herrmann
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Jürgen Schäfer
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
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12
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Whole-Body MRI for the Detection of Recurrence in Melanoma Patients at High Risk of Relapse. Cancers (Basel) 2021; 13:cancers13030442. [PMID: 33503861 PMCID: PMC7865287 DOI: 10.3390/cancers13030442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: No standard protocol for surveillance for melanoma patients is established. Whole-body magnetic resonance imaging (whole-body MRI) is a safe and sensitive technique that avoids exposure to X-rays and contrast agents. This prospective study explores the use of whole-body MRI for the early detection of recurrences. Material and Methods: Patients with American Joint Committee on Cancer Staging Manual (seventh edition; AJCC-7) stages IIIb/c or -IV melanoma who were disease-free following resection of macrometastases (cohort A), or obtained a durable complete response (CR) or partial response (PR) following systemic therapy (cohort B), were included. All patients underwent whole-body MRI, including T1, Short Tau Inversion Recovery, and diffusion-weighted imaging, every 4 months the first 3 years of follow-up and every 6 months in the following 2 years. A total body skin examination was performed every 6 months. Results: From November 2014 to November 2019, 111 patients were included (four screen failures, cohort A: 68 patients; cohort B: 39 patients). The median follow-up was 32 months. Twenty-six patients were diagnosed with suspected lesions. Of these, 15 patients were diagnosed with a recurrence on MRI. Eleven suspected lesions were considered to be of non-neoplastic origin. In addition, nine patients detected a solitary subcutaneous metastasis during self-examination, and two patients presented in between MRIs with recurrences. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 58%, 98%, 58%, 98%, and 98%. Sensitivity and specificity for the detection of distant metastases was respectively 88% and 98%. No patient experienced a clinically meaningful (>grade 1) adverse event. Conclusions: Whole-body MRI for the surveillance of melanoma patients is a safe and sensitive technique sparing patients' cumulative exposure to X-rays and contrast media.
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Summers P, Saia G, Colombo A, Pricolo P, Zugni F, Alessi S, Marvaso G, Jereczek-Fossa BA, Bellomi M, Petralia G. Whole-body magnetic resonance imaging: technique, guidelines and key applications. Ecancermedicalscience 2021; 15:1164. [PMID: 33680078 PMCID: PMC7929776 DOI: 10.3332/ecancer.2021.1164] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is an imaging method without ionising radiation that can provide WB coverage with a core protocol of essential imaging contrasts in less than 40 minutes, and it can be complemented with sequences to evaluate specific body regions as needed. In many cases, WB-MRI surpasses bone scintigraphy and computed tomography in detecting and characterising lesions, evaluating their response to therapy and in screening of high-risk patients. Consequently, international guidelines now recommend the use of WB-MRI in the management of patients with multiple myeloma, prostate cancer, melanoma and individuals with certain cancer predisposition syndromes. The use of WB-MRI is also growing for metastatic breast cancer, ovarian cancer and lymphoma as well as for cancer screening amongst the general population. In light of the increasing interest from clinicians and patients in WB-MRI as a radiation-free technique for guiding the management of cancer and for cancer screening, we review its technical basis, current international guidelines for its use and key applications.
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Affiliation(s)
- Paul Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Saia
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Advanced Screening Centers, ASC Italia, 24060 Castelli Calepio, Bergamo, Italy
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.,Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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14
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Isaac A, Lecouvet F, Dalili D, Fayad L, Pasoglou V, Papakonstantinou O, Ahlawat S, Messiou C, Weber MA, Padhani AR. Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging. Semin Musculoskelet Radiol 2020; 24:726-750. [PMID: 33307587 DOI: 10.1055/s-0040-1719018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is gradually being integrated into clinical pathways for the detection, characterization, and staging of malignant tumors including those arising in the musculoskeletal (MSK) system. Although further developments and research are needed, it is now recognized that WB-MRI enables reliable, sensitive, and specific detection and quantification of disease burden, with clinical applications for a variety of disease types and a particular application for skeletal involvement. Advances in imaging techniques now allow the reliable incorporation of WB-MRI into clinical pathways, and guidelines recommending its use are emerging. This review assesses the benefits, clinical applications, limitations, and future capabilities of WB-MRI in the context of other next-generation imaging modalities, as a qualitative and quantitative tool for the detection and characterization of skeletal and soft tissue MSK malignancies.
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Affiliation(s)
- Amanda Isaac
- School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom.,Guy's & St Thomas' Hospitals, London, United Kingdom
| | - Frederic Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Danoob Dalili
- School of Biomedical Engineering & Imaging Sciences, Kings College London, United Kingdom.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Laura Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, John's Hopkins School of Medicine, Baltimore, Maryland
| | - Vasiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Olympia Papakonstantinou
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, John's Hopkins School of Medicine, Baltimore, Maryland
| | - Christina Messiou
- The Royal Marsden Hospital, London, United Kingdom.,The Institute of Cancer Research, London, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Anwar R Padhani
- The Institute of Cancer Research, London, United Kingdom.,Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
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Busacchio D, Mazzocco K, Gandini S, Pricolo P, Masiero M, Summers PE, Pravettoni G, Petralia G. Preliminary observations regarding the expectations, acceptability and satisfaction of whole-body MRI in self-referring asymptomatic subjects. Br J Radiol 2020; 94:20191031. [PMID: 33237810 DOI: 10.1259/bjr.20191031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the satisfaction of asymptomatic subjects who self-referring Whole-Body Magnetic Resonance Imaging (WB-MRI) for early cancer diagnosis. METHODS Subjects completed a pre-examination questionnaire, while waiting for their WB-MRI examination, recording demographics, expected discomfort, perceived knowledge and usefulness of the procedure and health risk perceptions, as well as a post-examination questionnaire, measuring discomfort experienced, acceptability and satisfaction with WB-MRI. We examined which factors influenced discomfort and satisfaction associated with WB-MRI. RESULTS 65 asymptomatic subjects (median age 51; 29 females) completed the questionnaire. Before WB-MRI, 29% of subjects expected discomfort of some form with claustrophobia (27.7%) and exam duration (24.6%) being the most common concerns. Experienced discomfort due to shortness of breath was significantly lower than expected. This difference was significantly associated with the personal risk perception to get a disease (p = 0.01) and educational level (p = 0.002). More specifically, higher level of perceived personal risk of getting a disease and lower level of education were associated with higher expected than experienced discomfort. Similarly, experiencing less claustrophobia than expected was significantly associated with gender (p = 0.005) and more pronounced among females. A majority (83%) of subjects expressed high levels of satisfaction with WB-MRI for early cancer diagnosis and judged it more acceptable than other diagnostic exams. CONCLUSIONS Asymptomatic subjects self-referring to WB-MRI for early cancer diagnosis showed high levels of satisfaction and acceptability with the examination. Nevertheless, a relevant proportion of participants reported some form of discomfort. Interestingly, participants with higher perceived personal risk to get a disease, lower education and females showed to expect higher discomfort than experienced. ADVANCES IN KNOWLEDGE Scope exists for measures to assess expected feelings and develop personalized interventions to reduce the stress anticipated by individuals deciding to undergo WB-MRI for early cancer diagnosis.
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Affiliation(s)
- Derna Busacchio
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Masiero
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Paul Eugene Summers
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Grabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Precision Imaging and Research Unit - Department of Medical Imaging and Radiation Sciences, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Tunariu N, Blackledge M, Messiou C, Petralia G, Padhani A, Curcean S, Curcean A, Koh DM. What's New for Clinical Whole-body MRI (WB-MRI) in the 21st Century. Br J Radiol 2020; 93:20200562. [PMID: 32822545 PMCID: PMC8519652 DOI: 10.1259/bjr.20200562] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022] Open
Abstract
Whole-body MRI (WB-MRI) has evolved since its first introduction in the 1970s as an imaging technique to detect and survey disease across multiple sites and organ systems in the body. The development of diffusion-weighted MRI (DWI) has added a new dimension to the implementation of WB-MRI on modern scanners, offering excellent lesion-to-background contrast, while achieving acceptable spatial resolution to detect focal lesions 5 to 10 mm in size. MRI hardware and software advances have reduced acquisition times, with studies taking 40-50 min to complete.The rising awareness of medical radiation exposure coupled with the advantages of MRI has resulted in increased utilization of WB-MRI in oncology, paediatrics, rheumatological and musculoskeletal conditions and more recently in population screening. There is recognition that WB-MRI can be used to track disease evolution and monitor response heterogeneity in patients with cancer. There are also opportunities to combine WB-MRI with molecular imaging on PET-MRI systems to harness the strengths of hybrid imaging. The advent of artificial intelligence and machine learning will shorten image acquisition times and image analyses, making the technique more competitive against other imaging technologies.
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Affiliation(s)
| | - Matthew Blackledge
- Department of Radiotherapy, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Via Ripamonti, 435 - 20141 Milan, Italy
| | - Anwar Padhani
- Mount Vernon Hospital, The Paul Strickland Scanner Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Sebastian Curcean
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | | | - Dow-Mu Koh
- Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
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Zugni F, Padhani AR, Koh DM, Summers PE, Bellomi M, Petralia G. Whole-body magnetic resonance imaging (WB-MRI) for cancer screening in asymptomatic subjects of the general population: review and recommendations. Cancer Imaging 2020; 20:34. [PMID: 32393345 PMCID: PMC7216394 DOI: 10.1186/s40644-020-00315-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background The number of studies describing the use of whole-body magnetic resonance imaging (WB-MRI) for screening of malignant tumours in asymptomatic subjects is increasing. Our aim is to review the methodologies used and the results of the published studies on per patient and per lesion analysis, and to provide recommendations on the use of WB-MRI for cancer screening. Main body We identified 12 studies, encompassing 6214 WB-MRI examinations, which provided the rates of abnormal findings and findings suspicious for cancer in asymptomatic subjects, from the general population. Eleven of 12 studies provided imaging protocols that included T1- and T2-weighted sequences, while only five included diffusion weighted imaging (DWI) of the whole body. Different categorical systems were used for the classification and the management of abnormal findings. Of 17,961 abnormal findings reported, 91% were benign, while 9% were oncologically relevant, requiring further investigations, and 0.5% of lesions were suspicious for cancer. A per-subject analysis showed that just 5% of subjects had no abnormal findings, while 95% had abnormal findings. Findings requiring further investigation were reported in 30% of all subjects, though in only 1.8% cancer was suspected. The overall rate of histologically confirmed cancer was 1.1%. Conclusion WB-MRI studies of cancer screening in the asymptomatic general population are too heterogeneous to draw impactful conclusions regarding efficacy. A 5-point lesion scale based on the oncological relevance of findings appears the most appropriate for risk-based management stratification. WB-MRI examinations should be reported by experienced oncological radiologists versed on WB-MRI reading abnormalities and on onward referral pathways.
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Affiliation(s)
- Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
| | - Anwar Roshanali Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital (Surrey), Downs Rd, Sutton, SM2 5PT, UK
| | - Paul Eugene Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via S. Sofia, 9/1, 20122, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Via S. Sofia, 9/1, 20122, Milan, Italy.,Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
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18
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The role of diffusion-weighted and dynamic contrast enhancement perfusion-weighted imaging in the evaluation of salivary glands neoplasms. Radiol Med 2020; 125:851-863. [PMID: 32266692 DOI: 10.1007/s11547-020-01182-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/23/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the association of magnetic resonance diffusion-weighted imaging (DwI) and dynamic contrast-enhanced perfusion-weighted imaging (DCE-PwI) with a temporal resolution of 5 s, wash-in < 120 s, and wash-out ratio > 30% in the evaluation of salivary glands neoplasms. METHODS DwI and DCE-PwI of 92 salivary glands neoplasms were assessed. The apparent diffusion coefficient (ADC) was calculated by drawing three regions of interest with an average area of 0.30-0.40 cm2 on three contiguous axial sections. The time/intensity curve was generated from DCE-PwI images by drawing a region of interest that included at least 50% of the largest lesion section. Vessels, calcifications, and necrotic/haemorrhagic or cystic areas within solid components were excluded. The association of ADC ≥ 1.4 × 10-3 mm2/s with type A curves (progressive wash-in) and ADC 0.9-1.4 × 10-3 mm2/s with type C curves (rapid wash-in/slow wash-out) were tested as parameters of benignity and malignancy, respectively. Type B curve (rapid wash-in/rapid wash-out) was not used as a reference parameter. RESULTS ADC ≥ 1.4 × 10-3 mm2/s and type A curves were observed only in benign neoplasms. ADC of 0.9-1.4 × 10-3 mm2/s and type C curves association showed specificity of 94.9% and positive predictive value of 81.8% for epithelial malignancies. The association of ADC < 0.9 × 10-3 mm2/s with type B and C curves showed diagnostic accuracy of 94.6% and 100% for Warthin tumour and lymphoma, respectively. CONCLUSIONS ADC ≥ 1.4 × 10-3 mm2/s and type A curves association was indicative of benignity. Lymphomas exhibited ADC < 0.7 × 10-3 mm2/s and type C curves. The association of ADC < 0.9 × 10-3 mm2/s and type B and C curves had accuracy 94.6% and 88.5% for Warthin tumour and epithelial malignancies, respectively.
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Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS, Beare S, Bridgewater J, Goh V, Janes S, Koh DM, Morton A, Navani N, Oliver A, Padhani A, Punwani S, Rockall A, Halligan S. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health Technol Assess 2019; 23:1-270. [PMID: 31855148 PMCID: PMC6936168 DOI: 10.3310/hta23660] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN The design was a prospective multicentre cohort study. SETTING The setting was 16 NHS hospitals. PARTICIPANTS Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Susan Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, and Priment Clinical Trials Unit, University College London, London, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Sutton, UK
| | - Alison Morton
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Alfred Oliver
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Anwar Padhani
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Andrea Rockall
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
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20
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Abstract
Melanoma accounts for 7% of all cancers in adolescents ages 15-19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1-4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.
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Affiliation(s)
- Sue C Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN 220, Memphis, TN, 38105-3678, USA.
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
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21
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Ao W, Wang J, Mao G, Yang G, Han X, Jia Y, Cheng Y. Primary hepatic melanoma: A case report of computed tomography and magnetic resonance imaging findings. Medicine (Baltimore) 2019; 98:e16165. [PMID: 31232974 PMCID: PMC6636915 DOI: 10.1097/md.0000000000016165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Malignant melanoma predominantly develops in middle-aged and older adults, most commonly occurring on the skin and rarely on internal organs. Malignant melanoma originating in the liver is extremely rare. Imaging findings of primary hepatic melanoma (PHM) are scarce in relevant literature. PATIENT CONCERNS The patient was a 69-year-old woman from Zhejiang, China, who was admitted to the hospital because of upper abdominal pain that persisted for >10 days. DIAGNOSES Computed tomography (CT) findings indicated the presence of a circular low-density shadow of approximately 7.5 × 8.0 cm in the hepatic hilar region. Magnetic resonance imaging (MRI) indicated a heterogeneous solid cystic mass in the hepatic hilar region. The mass exhibited heterogeneous low-signal intensity on a T1-weighted image (T1WI) and slightly higher signal intensity on a T2-weighted image (T2WI). The tumor appeared as multiple irregular strips with high-signal intensity on T1WI and low-signal intensity on T2WI. The diffusion-weighted image revealed increased signal intensity. The tumor continued to be enhanced after enhancement. Clinical data suggested that the tumor was a malignant liver tumor. INTERVENTIONS The patient underwent a CT guide puncture hepatic biopsy. The tumor was located in the hepatic hilar region adjacent to the large blood vessels and invaded the portal vein. Because a resection was highly risky, conservative treatment was conducted. OUTCOMES Postoperative pathology and clinical examination confirmed that the tumor was malignant PHM. The patient has been followed up for 6 months. The patient underwent CT reexamination 2 months after conservative treatment, the results of which revealed that the tumor progressed. Multiple lesions were identified; moreover, the tumor size had increased and the tumor had invaded the portal vein and intrahepatic bile duct. The patient was reexamined by CT in another hospital 6 months after conservative treatment. The results revealed peritoneal, omental metastases and multi bone metastases. LESSONS To our best knowledge, this is the first reported case of a PHM with complete imaging data, including preoperative CT and MRI examinations and a follow-up CT examination. From compiling the CT and MRI findings of this patient and those of relevant studies, this study can serve as a reference for the preoperative diagnosis and differential diagnosis of PHM.
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Affiliation(s)
| | | | | | | | - Xiaoyu Han
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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22
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Petralia G, Padhani AR. Whole-Body Magnetic Resonance Imaging in Oncology: Uses and Indications. Magn Reson Imaging Clin N Am 2019; 26:495-507. [PMID: 30316463 DOI: 10.1016/j.mric.2018.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Whole-body MRI (WB-MRI) has emerged as a radiation-free method for the diagnosis, staging, and therapy response assessments in cancer patients. This article reviews the current roles for WB-MRI in the clinical context of limitations of currently used techniques, focusing on bone marrow disease applications. Indication for broader clinical use are discussed, including guideline recommendations. The emerging screening role of WB-MRI in subjects at high risk of cancer is discussed, as is normal population screening.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology, IEO - European Institute of Oncology IRCCS, Via Ripamonti, 435, Milan 20141, Italy; Department of Oncology and Hematology, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy.
| | - Anwar R Padhani
- MR unit, Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
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23
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Petralia G, Padhani AR, Pricolo P, Zugni F, Martinetti M, Summers PE, Grazioli L, Colagrande S, Giovagnoni A, Bellomi M. Whole-body magnetic resonance imaging (WB-MRI) in oncology: recommendations and key uses. Radiol Med 2018; 124:218-233. [PMID: 30430385 DOI: 10.1007/s11547-018-0955-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
The past decade has witnessed a growing role and increasing use of whole-body magnetic resonance imaging (WB-MRI). Driving these successes are developments in both hardware and software that have reduced overall examination times and significantly improved MR imaging quality. In addition, radiologists and clinicians have continued to find promising new applications of this innovative imaging technique that brings together morphologic and functional characterization of tissues. In oncology, the role of WB-MRI has expanded to the point of being recommended in international guidelines for the assessment of several cancer histotypes (multiple myeloma, melanoma, prostate cancer) and cancer-prone syndromes (Li-Fraumeni and hereditary paraganglioma-pheochromocytoma syndromes). The literature shows growing use of WB-MRI for the staging and follow-up of other cancer histotypes and cancer-related syndromes (including breast cancer, lymphoma, neurofibromatosis, and von Hippel-Lindau syndromes). The main aim of this review is to examine the current scientific evidence for the use of WB-MRI in oncology.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Paola Pricolo
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Zugni
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Marco Martinetti
- Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Paul E Summers
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Luigi Grazioli
- First Department of Radiology, Civic and University Hospital of Brescia, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Bellomi
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
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24
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Whole-Body MR Imaging: The Novel, "Intrinsically Hybrid," Approach to Metastases, Myeloma, Lymphoma, in Bones and Beyond. PET Clin 2018; 13:505-522. [PMID: 30219185 DOI: 10.1016/j.cpet.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Whole-body MR imaging (WB-MR imaging) has become a modality of choice for detecting bone metastases in multiple cancers, and bone marrow involvement by multiple myeloma or lymphoma. Combination of anatomic and functional sequences imparts an inherently hybrid dimension to this nonirradiating tool and extends the screening of malignancies outside the skeleton. WB-MR imaging outperforms bone scintigraphy and CT and offers an alternative to PET in many tumors by time of lesion detection and assessment of treatment response. Much work has been done to standardize procedures, optimize sequences, validate indications, confirm preliminary research into new applications, rendering clinical application more user-friendly.
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25
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Oliveri S, Pricolo P, Pizzoli S, Faccio F, Lampis V, Summers P, Petralia G, Pravettoni G. Investigating cancer patient acceptance of Whole Body MRI. Clin Imaging 2018; 52:246-251. [PMID: 30170274 DOI: 10.1016/j.clinimag.2018.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Whole Body magnetic resonance imaging (WB-MRI) enables early cancer detection, without exposing the patient to ionizing radiation. Our aim was to investigate patients' acceptance of WB-MRI as a procedure for cancer staging and follow up. MATERIALS AND METHODS 135 oncologic subjects participated to the study. An ad hoc questionnaire was administered before and after WB-MRI, to assess patient's confidence and concerns about WB-MRI, psychological reactions, experience and perceived utility of the procedure. RESULTS Before undergoing WB-MRI, about 58% of the patients were concerned for cancer progression outcome. 80.4% felt that they were given good information about the exam and the most informed group also perceived and higher level of utility of WB-MRI and no risk. Among people reporting discomfort with the exam (51.9%) the main reasons were noise and exam duration. Despite this, 80% of patients expressed high levels of satisfaction, and the majority (69%) judged WB-MRI more acceptable than other diagnostic exams. Patients who believed to have received more information before the exam rated their global satisfaction higher. CONCLUSION Our results show that WB-MRI examinations were well-accepted and perceived with high levels of satisfaction by most patients. WB-MRI appears to be equally or more tolerable than other total body imaging modalities (e.g. PET, CT), especially if they receive enough information from the radiologist.
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Affiliation(s)
- Serena Oliveri
- Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milan, Italy.
| | - Paola Pricolo
- Radiology Division, IEO Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milan, Italy
| | - Silvia Pizzoli
- Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Flavia Faccio
- Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Valentina Lampis
- Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milan, Italy
| | - Paul Summers
- Radiology Division, IEO Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Radiology Division, IEO Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milan, Italy
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26
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Stecco A, Trisoglio A, Soligo E, Berardo S, Sukhovei L, Carriero A. Whole-Body MRI with Diffusion-Weighted Imaging in Bone Metastases: A Narrative Review. Diagnostics (Basel) 2018; 8:diagnostics8030045. [PMID: 29987207 PMCID: PMC6163267 DOI: 10.3390/diagnostics8030045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/29/2018] [Accepted: 07/04/2018] [Indexed: 12/12/2022] Open
Abstract
Whole body magnetic resonance imaging (MRI) with diffusion-weighted imaging (WB-MRI-DWI) is currently emerging as a diagnostic technique in the evaluation of bone metastases from breast, prostate, lung, thyroid, and melanoma tumors. The most relevant articles regarding the detection of solid tumor bone metastases with MRI have been reviewed and cited. The imaging methods currently used in the detection of bone metastases are bone scintigraphy, computed tomography (CT), and positron emission tomography (PET/CT) with 2-deoxy-2-[fluorine-18] fluoro-d-glucose (18F-FDG PET/CT). WB-MRI-DWI allows qualitative and quantitative evaluation of focal lesions through signal intensity evaluation on DWI images and the reconstruction of the apparent diffusion coefficient (ADC) map. In prostate and breast cancer, WB-MRI-DWI is useful in assessing the response of bone lesions to therapy and to detecting early non-responders, while in lung cancer the method shows a similar sensitivity to 18F-FDG PET/CT in the detection of bone metastases. In bone metastases of thyroid tumors and melanoma, the WB-MRI-DWI shows a higher sensitivity when compared to 18F-FDG PET/CT. With a standardization of the WB-MRI-DWI protocol, this method seems to play an important role in the diagnosis of bone solid tumor metastases.
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Affiliation(s)
- Alessandro Stecco
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Alessandra Trisoglio
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Eleonora Soligo
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Sara Berardo
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Lidiia Sukhovei
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Alessandro Carriero
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
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27
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Pasoglou V, Michoux N, Larbi A, Van Nieuwenhove S, Lecouvet F. Whole Body MRI and oncology: recent major advances. Br J Radiol 2018; 91:20170664. [PMID: 29334236 DOI: 10.1259/bjr.20170664] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
MRI is a very attractive approach for tumour detection and oncological staging with its absence of ionizing radiation, high soft tissue contrast and spatial resolution. Less than 10 years ago the use of Whole Body MRI (WB-MRI) protocols was uncommon due to many limitations, such as the forbidding acquisition times and limited availability. This decade has marked substantial progress in WB-MRI protocols. This very promising technique is rapidly arising from the research world and is becoming a commonly used examination for tumour detection due to recent technological developments and validation of WB-MRI by multiple studies and consensus papers. As a result, WB-MRI is progressively proposed by radiologists as an efficient examination for an expanding range of indications. As the spectrum of its uses becomes wider, radiologists will soon be confronted with the challenges of this technique and be urged to be trained in order to accurately read and report these examinations. The aim of this review is to summarize the validated indications of WB-MRI and present an overview of its most recent advances. This paper will briefly discuss how this examination is performed and which are the recommended sequences along with the future perspectives in the field.
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Affiliation(s)
- Vassiliki Pasoglou
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Nicolas Michoux
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Ahmed Larbi
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium.,2 Department of Radiology, Nimes University Hospital , Nimes , France
| | - Sandy Van Nieuwenhove
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Frédéric Lecouvet
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
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28
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Pasoglou V, Michoux N, Larbi A, Van Nieuwenhove S, Lecouvet F. Whole Body MRI and oncology: recent major advances. Br J Radiol 2018. [PMID: 29334236 DOI: 10.1259/bjr.20170664%0a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
MRI is a very attractive approach for tumour detection and oncological staging with its absence of ionizing radiation, high soft tissue contrast and spatial resolution. Less than 10 years ago the use of Whole Body MRI (WB-MRI) protocols was uncommon due to many limitations, such as the forbidding acquisition times and limited availability. This decade has marked substantial progress in WB-MRI protocols. This very promising technique is rapidly arising from the research world and is becoming a commonly used examination for tumour detection due to recent technological developments and validation of WB-MRI by multiple studies and consensus papers. As a result, WB-MRI is progressively proposed by radiologists as an efficient examination for an expanding range of indications. As the spectrum of its uses becomes wider, radiologists will soon be confronted with the challenges of this technique and be urged to be trained in order to accurately read and report these examinations. The aim of this review is to summarize the validated indications of WB-MRI and present an overview of its most recent advances. This paper will briefly discuss how this examination is performed and which are the recommended sequences along with the future perspectives in the field.
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Affiliation(s)
- Vassiliki Pasoglou
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Nicolas Michoux
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Ahmed Larbi
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium.,2 Department of Radiology, Nimes University Hospital , Nimes , France
| | - Sandy Van Nieuwenhove
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Frédéric Lecouvet
- 1 Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain , Brussels , Belgium
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29
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Han SN, Amant F, Michielsen K, De Keyzer F, Fieuws S, Van Calsteren K, Dresen RC, Gziri MM, Vandecaveye V. Feasibility of whole-body diffusion-weighted MRI for detection of primary tumour, nodal and distant metastases in women with cancer during pregnancy: a pilot study. Eur Radiol 2017; 28:1862-1874. [PMID: 29218610 DOI: 10.1007/s00330-017-5126-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 09/28/2017] [Accepted: 10/11/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the feasibility of whole-body diffusion-weighted MRI (WB-DWI/MRI) for detecting primary tumour, nodal and distant metastases in pregnant women with cancer. METHODS Twenty pregnant patients underwent WB-DWI/MRI in additional to conventional imaging. Reproducibility of WB-DWI/MRI between two readers was evaluated using Cohen's κ statistics and accuracy was compared to conventional imaging for assessing primary tumour site, nodal and visceral metastases. RESULTS Both WB-DWI/MRI readers showed good-very good agreement for lesion detection (primary lesions: κ=1; lymph nodes: κ=0.89; distant metastases: κ=0.61). Eight (40 %) patients were upstaged after WB-DWI/MRI. For nodal metastases, WB-DWI/MRI showed 100 % (95 % CI: 83.2-100) sensitivity for both readers with specificity of 99.4 % (96.9-100) and 100 % (80.5-100) for readers 1 and 2, respectively. For distant metastases, WB-DWI/MRI showed 66.7 % (9.4-99.2) and 100 % (29.2-100) sensitivity and specificity of 94.1 % (71.3-99.9) and 100 % (80.5-100) for readers 1 and 2, respectively. Conventional imaging showed sensitivity of 50 % (27.2-72.8) and 33.3 % (0.8-90.6); specificity of 100 % (98-100) and 100 % (80.5-100), for nodal and distant metastases respectively. CONCLUSIONS WB-DWI/MRI is feasible for single-step non-invasive staging of cancer during pregnancy with additional value for conventional imaging procedures. KEY POINTS • In our study, WB-DWI/MRI was more accurate than conventional imaging during pregnancy. • WB-DWI/MRI improves diagnostic assessment of patients with cancer during pregnancy. • Accurate imaging and oncologic staging improves treatment and outcome.
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Affiliation(s)
- Sileny N Han
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Frédéric Amant
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. .,Center for Gynaecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | | | | | - Steffen Fieuws
- Department of Public Health and Primary Care, KU Leuven - University of Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Kristel Van Calsteren
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | | | - Mina Mhallem Gziri
- Obstetrics and Gynaecology, Cliniques Universitaires Saint-Luc, Woluwe Saint-Lambert, Belgium
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30
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Seith F, Forschner A, Schmidt H, Pfannenberg C, Gückel B, Nikolaou K, la Fougère C, Garbe C, Schwenzer N. 18F-FDG-PET detects complete response to PD1-therapy in melanoma patients two weeks after therapy start. Eur J Nucl Med Mol Imaging 2017; 45:95-101. [PMID: 28831583 DOI: 10.1007/s00259-017-3813-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/15/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of the study was to evaluate if 18F-FDG-PET has the potential to detect complete responders to PD1-therapy in patients with unresectable metastasized melanoma two weeks after therapy initiation. METHODS Between September 2014 and May 2016, ten patients (four females; 65 ± 12 y) received a whole-body 18F-FDG-PET/MRI examination at three time points: Before therapy start (t0, base-line), two weeks (t1, study examination) and three months after treatment initiation (t2, reference standard). Therapy response was assessed with PET response criteria in solid tumors (PERCIST). Time to progression and overall survival (OS) were obtained for all patients. RESULTS Three patients with partial metabolic response in PET at t1 turned out to have complete response at t2. No tumor relapse was observed in those patients so far (observation period: 265, 511 and 728 days, respectively). At t2, progressive metabolic disease (PMD) was seen in six patients from whom four showed PMD and two showed stable metabolic disease (SMD) at t1. OS in patients with PMD at t2 varied between 148 and 814 days. SMD at both t1 and t2 was seen in one patient, tumor progress was observed after 308 days. CONCLUSION Our study indicates that whole-body 18F-FDG-PET might be able to reliably identify complete responders to PD1-therapy as early as two weeks after therapy initiation in stage IV melanoma patients. This might help to shorten therapy regimes and avoid unnecessary side effects in the future.
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Affiliation(s)
- Ferdinand Seith
- Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
| | - Andrea Forschner
- Department of Dermatology, Eberhard Karls University, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Holger Schmidt
- Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
| | - Christina Pfannenberg
- Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
| | - Brigitte Gückel
- Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
| | - Konstantin Nikolaou
- Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christian la Fougère
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Eberhard Karls University, Otfried-Mueller-Strasse 14, 72076, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Nina Schwenzer
- Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
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31
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Peccatori FA, Codacci-Pisanelli G, Del Grande M, Scarfone G, Zugni F, Petralia G. Whole body MRI for systemic staging of breast cancer in pregnant women. Breast 2017; 35:177-181. [PMID: 28756339 DOI: 10.1016/j.breast.2017.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/16/2022] Open
Abstract
When breast cancer is diagnosed during pregnancy, treatment should be as close; as possible to what is used in non-pregnant patients. This requires accurate local and systemic staging: ultrasound (US) is used for local staging and allows adequate evaluation of the liver and pelvis, but chest and bones cannot be explored and imaging techniques involving exposure to ionizing radiation would be needed. However, since imaging techniques involving ionizing radiation and the use of radionuclides should be limited, whole body magnetic resonance imaging (WB-MRI) without administration of contrast agent represents a very interesting alternative, but limited data is available. In this paper we describe the obstetrical and oncological outcome of 14 patients in whom breast cancer was diagnosed during the second or third trimester of pregnancy and that were staged using WB-MRI. Median age of the patient at diagnosis was 35 years (range 20-36), median gestational age at MRI was 30 weeks (range 13-32) and median age at delivery was 38 weeks (range 32-38). At birth, one new-born presented respiratory distress syndrome and one jaundice. We conclude that diffusion-weighted MRI is feasible accurate and safe for the mother and for the foetus. It may represent the staging technique of choice in pregnant women diagnosed with breast cancer after the first trimester of pregnancy.
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Affiliation(s)
- Fedro A Peccatori
- Fertility and Procreation Unit, Department of Gynaecological Oncology, European Institute of Oncology (IEO), Milan, Italy
| | | | - Maria Del Grande
- Fertility and Procreation Unit, Department of Gynaecological Oncology, European Institute of Oncology (IEO), Milan, Italy
| | - Giovanna Scarfone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Zugni
- Post-graduation School in Radiodiagnostics, University of Milan, Italy
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology (IEO), Milan, Italy
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Taylor SA, Mallett S, Miles A, Beare S, Bhatnagar G, Bridgewater J, Glynne-Jones R, Goh V, Groves AM, Janes SM, Koh DM, Morris S, Morton A, Navani N, Oliver A, Padhani AR, Punwani S, Rockall AG, Halligan S. Streamlining staging of lung and colorectal cancer with whole body MRI; study protocols for two multicentre, non-randomised, single-arm, prospective diagnostic accuracy studies (Streamline C and Streamline L). BMC Cancer 2017; 17:299. [PMID: 28464835 PMCID: PMC5412056 DOI: 10.1186/s12885-017-3281-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/13/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIMS Rapid and accurate cancer staging following diagnosis underpins patient management, in particular the identification of distant metastatic disease. Current staging guidelines recommend sequential deployment of various imaging platforms such as computerised tomography (CT) and positron emission tomography (PET) which can be time and resource intensive and onerous for patients. Recent studies demonstrate that whole body magnetic resonance Imaging (WB-MRI) may stage cancer efficiently in a single visit, with potentially greater accuracy than current staging investigations. The Streamline trials aim to evaluate whether WB-MRI increases per patient detection of metastases in non-small cell lung and colorectal cancer compared to standard staging pathways. METHODS The Streamline trials are multicentre, non-randomised, single-arm, prospective diagnostic accuracy studies with a novel design to capture patient management decisions during staging pathways. The two trials recruit adult patients with proven or highly suspected new diagnosis of primary colorectal (Streamline C) or non-small cell lung cancer (Streamline L) referred for staging. Patients undergo WB-MRI in addition to standard staging investigations. Strict blinding protocols are enforced for those interpreting the imaging. A first major treatment decision is made by the multi-disciplinary team prior to WB-MRI revelation based on standard staging investigations only, then based on the WB-MRI and any additional tests precipitated by WB-MRI, and finally based on all available test results. The reference standard is derived by a multidisciplinary consensus panel who assess 12 months of follow-up data to adjudicate on the TNM stage at diagnosis. Health psychology assessment of patients' experiences of the cancer staging pathway will be undertaken via interviews and questionnaires. A cost (effectiveness) analysis of WB-MRI compared to standard staging pathways will be performed. DISCUSSION We describe a novel approach to radiologist and clinician blinding to ascertain the 'true' diagnostic accuracy of differing imaging pathways and discuss our approach to assessing the impact of WB-MRI on clinical decision making in real-time. The Streamline trials will compare WB-MRI and standard imaging pathways in the same patients, thereby informing the most accurate and efficient approach to staging. TRIAL REGISTRATION Streamline C ISRCTN43958015 (registered 25/7/2012). Streamline L ISRCTN50436483 (registered 31/7/2012).
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Affiliation(s)
- Stuart A. Taylor
- Centre for Medical Imaging, University College London, 250 Euston Road, London, NW1 2BU UK
| | - Sue Mallett
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Anne Miles
- Birkbeck, University of London, Malet Street, London, WC1E 7HX UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, 90 Tottenham Court Road, London, W1T 4TJ UK
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, 250 Euston Road, London, NW1 2BU UK
| | - John Bridgewater
- UCL Cancer Institute, Paul O Gorman Building, 72 Huntley Street London, London, WC1E 6DD UK
| | - Rob Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Rickmansworth Road, Northwood, MIDDX, HA6 2RN UK
| | - Vicky Goh
- Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering Kings College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, University College London, Euston Rd, London, UK
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, 5 University Street, London, WC1E 6JF UK
| | - Dow Mu Koh
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Steve Morris
- Department of Applied Health Research, University College London, 1-19 Torrington Pl, Fitzrovia, London, WC1E 7HB UK
| | - Alison Morton
- C/O National Cancer Research Institute, 407 St Johns Street, London, EC1V 4AD UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, 5 University Street, London, WC1E 6JF UK
- Department of Thoracic Medicine, University College London Hospital, 250 Euston Road, London, NW1 2PG UK
| | - Alf Oliver
- C/O National Cancer Research Institute, 407 St Johns Street, London, EC1V 4AD UK
| | - Anwar R. Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 250 Euston Road, London, NW1 2BU UK
| | - Andrea G. Rockall
- Department of Radiology, Royal Marsden NHS Foundation Trust, Fulham Rd London, London, SW3 6JJ UK
- Division of Cancer and Surgery, Faculty of Medicine, Hammersmith Campus, Imperial College London, London, W12 ONN UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 250 Euston Road, London, NW1 2BU UK
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33
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Signal intensity change on unenhanced T1-weighted images in dentate nucleus and globus pallidus after multiple administrations of gadoxetate disodium: an intraindividual comparative study. Eur Radiol 2017; 27:4372-4378. [PMID: 28357495 DOI: 10.1007/s00330-017-4810-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/13/2017] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate whether there is an increased signal intensity (SI) of dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted magnetic resonance imaging (MRI), in patients who had undergone multiple administrations of gadoxetate disodium. MATERIALS AND METHODS We retrospectevely included stage III melanoma patients, who had been previously enrolled in a trial of adjuvant therapy and who had undergone whole-body contrast-enhanced MRIs with gadoxetate disodium every three months for their follow-up. The SI ratios of DN-to-pons and GP-to-thalamus on unenhanced T1-weighted images were calculated. The difference in SI ratios between the first and the last MRI examinations was assessed and a linear mixed model was performed to detect how SI ratios varied with the number of administrations. RESULTS Eighteen patients were included in our study. The number of gadoxetate disodium administrations ranged from 2 to 18. Paired t-test did not show any significant difference in DN-to-pons (p=0.21) and GP-to-thalamus (p=0.09) SI ratios by the end of the study. DN-to-pons SI ratio and GP-to-thalamus SI ratio did not significantly increase with increasing the number of administrations (p=0.14 and p=0.06, respectively). CONCLUSION Multiple administrations of gadoxetate disodium are not associated with increased SI in DN and GP in the brain. KEY POINTS • Gadolinium may deposit in the human brain after multiple GBCA administrations. • Gadolinium deposition is associated with increased T1W signal intensity • Increase in signal intensity is most apparent within the DN and GP • Multiple administrations of gadoxetate disodium do not increase T1W signal.
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34
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Balasubramanya R, Selvarajan SK, Cox M, Joshi G, Deshmukh S, Mitchell DG, O'Kane P. Imaging of ocular melanoma metastasis. Br J Radiol 2016; 89:20160092. [PMID: 27168029 DOI: 10.1259/bjr.20160092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Ocular melanoma is the most common adult primary intraocular tumour. Although <1% of patients have metastatic disease at the time of initial diagnosis, most will develop metastasis at varying lengths of time. Metastasis surveillance is therefore critical in the follow-up of patients with ocular melanoma. Liver is the most common site of metastasis and prognosis is based on the treatment of liver metastasis. Hence, imaging of liver metastasis is vital. MRI is the most specific modality for imaging liver metastasis and is at least as sensitive as CT. Extrahepatic metastasis such as retroperitoneal nodules and bone metastases are also better evaluated on MRI. Gadolinium-based contrast agents are extremely helpful for detecting liver lesions. In particular, newer hepatobiliary contrast agents which offer an additional hepatobiliary phase of excretion help in the detection of even tiny liver metastases. Diffusion-weighted imaging is helpful when an i.v. contrast cannot be administered. Treated lesions are also better evaluated with MRI. CT is useful for evaluating lung nodules, large liver metastasis or in patients in whom MRI is medically contraindicated. The disadvantage lies in its inability to detect small liver metastasis and the radiation dose involved. The lesions treated with iodized oil as part of chemoembolization procedures can be followed on CT. Ultrasound can be used only for detecting hepatic metastases. However, it is heavily operator dependent, technically challenging and time consuming especially in patients who are large. Extrahepatic metastasis cannot be seen on ultrasound. Its utility is primarily for the biopsy of liver lesions. Positron emission tomography (PET)-CT can detect lung nodules and large liver lesions but is insensitive to small liver lesions. Moreover, the high radiation dose is a major disadvantage.
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Affiliation(s)
| | | | - Mougnyan Cox
- 2 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ganesh Joshi
- 2 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sandeep Deshmukh
- 2 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Donald G Mitchell
- 2 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Patrick O'Kane
- 2 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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35
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Abstract
With the introduction of hybrid imaging technologies such as PET/CT and recently PET/MRI, staging and therapy-response monitoring have evolved. PET/CT has been shown to be of value for routine staging of FDG-avid lymphomas before as well as at the end of treatment. For interim staging, trials are ongoing to evaluate the use of PET/CT. In melanoma, PET/CT can be recommended for stages III and IV diseases for initial staging and before surgery. Studies investigating the use of PET/CT for early therapy response are promising. The role of PET/MR in lymphoma and melanoma imaging has to be defined because no larger studies exist so far. There may be an application of PET/MR in research especially for tumor characterization and therapy response. Furthermore, the potential role of non-FDG tracers is elucidated regarding the assessment of treatment response in targeted drug regimens.
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Affiliation(s)
- Nina F Schwenzer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Anna Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
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36
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Pfannenberg C, Schwenzer N. [Whole-body staging of malignant melanoma: advantages, limitations and current importance of PET-CT, whole-body MRI and PET-MRI]. Radiologe 2015; 55:120-6. [PMID: 25589421 DOI: 10.1007/s00117-014-2762-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cross-sectional imaging methods are currently the standard methods for staging of advanced melanoma. The former time-consuming and expensive multimodality approach is increasingly being replaced by novel whole-body (WB) staging methods, such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET-CT) and whole-body magnetic resonance imaging (WBMRI) because they offer a complete head-to-toe coverage of the patient in a single examination with an accurate and sensitive detection of tumor spread. Several studies in patients with advanced melanoma revealed that PET-CT is more sensitive and specific than conventional modalities, such as CT alone resulting in a change of management in up to 30 % of cases. Due to the limited sensitivity of PET for lesions smaller than 1 cm, PET-CT is not useful for the initial work-up of patients with stage I and II melanoma but has proven to be superior for detection of distant metastases, which is essential prior to surgical metastasectomy. If PET-CT is not available WB-CT or WB-MRI can alternatively be used and WB-MRI including diffusion-weighted imaging (DWI) has become a real alternative for staging of melanoma patients. So far, however, only few reports suffering from small numbers of cases and heterogeneous design have compared the diagnostic performance of WB-MRI and PET-CT. The preliminary results indicate a high overall diagnostic accuracy of both methods; however, these methods differ in organ-based detection rates: PET-CT was more accurate in N-staging and detection of lung and soft tissue metastases whereas WB-MRI was superior in detecting liver, bone and brain metastases. The value of PET-MRI for staging of advanced melanoma is the subject of ongoing clinical studies.
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Affiliation(s)
- C Pfannenberg
- Abteilung Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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37
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Foti PV, Farina R, Coronella M, Palmucci S, Montana A, Sigona A, Reibaldi M, Longo A, Russo A, Avitabile T, Caltabiano R, Puzzo L, Ragusa M, Mariotti C, Milone P, Ettorre GC. Diffusion-weighted magnetic resonance imaging for predicting and detecting the response of ocular melanoma to proton beam therapy: initial results. Radiol Med 2015; 120:526-35. [PMID: 25578783 DOI: 10.1007/s11547-014-0488-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to investigate the utility of diffusion-weighted magnetic resonance (MR) imaging for prediction and early detection of response to proton beam therapy in ocular melanoma. MATERIALS AND METHODS Ten ocular melanoma patients treated with proton beam therapy were enrolled in the study. All patients underwent conventional MR imaging and diffusion-weighted imaging (DWI) before the start of therapy, and after 1, 3 and 6 months of therapy. Tumour volumes and apparent diffusion coefficient (ADC) values of ocular lesions were measured at each examination. Tumour volumes and mean ADC measurements of the four examination series were compared; correlation of ADC values and tumour regression was investigated. RESULTS Mean ADC value of ocular melanomas significantly increased as early as 3 months after therapy; tumour volume significantly decreased as early as 6 months after therapy. The ADC values of ocular melanomas before therapy significantly correlated with tumour regression. CONCLUSIONS DWI may provide an early surrogate biomarker for prediction and early detection of tumour response to eye-preserving therapies in ocular melanoma.
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Affiliation(s)
- Pietro Valerio Foti
- Dipartimento Specialità Medico-Chirurgiche, Sezione di Scienze Radiologiche, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy,
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