Clinical Evaluation of an Abbreviated Contrast-Enhanced Whole-Body MRI for Oncologic Follow-Up Imaging

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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Value of whole body MRI and dynamic contrast enhanced MRI in the diagnosis, follow-up and evaluation of disease activity and extent in multiple myeloma

European Journal of Radiology ◽

10.1016/j.ejrad.2013.04.012 ◽

2013 ◽

Vol 82 (9) ◽

pp. 1444-1452 ◽

Cited By ~ 47

Author(s):

Julie C. Dutoit ◽

Matthias A. Vanderkerken ◽

Koenraad L. Verstraete

Keyword(s):

Multiple Myeloma ◽

Disease Activity ◽

Whole Body ◽

Whole Body Mri ◽

Dynamic Contrast Enhanced Mri ◽

Dynamic Contrast Enhanced ◽

Enhanced Mri ◽

Contrast Enhanced ◽

Contrast Enhanced Mri

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Spatial Distribution of Focal Lesions in Whole-Body MRI and Influence of MRI Protocol on Staging in Patients with Smoldering Multiple Myeloma According to the New SLiM-CRAB-Criteria

Cancers ◽

10.3390/cancers12092537 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2537

Author(s):

Markus Wennmann ◽

Thomas Hielscher ◽

Laurent Kintzelé ◽

Bjoern H. Menze ◽

Georg Langs ◽

...

Keyword(s):

Multiple Myeloma ◽

Spatial Distribution ◽

Whole Body ◽

Focal Lesion ◽

Focal Lesions ◽

Whole Body Mri ◽

Smoldering Multiple Myeloma ◽

Mri Protocol ◽

Prognostic Data

The purpose of this study was to assess how different MRI protocols (spinal vs. spinal plus pelvic vs. whole-body (wb)-MRI) affect staging in patients with smoldering multiple myeloma (SMM), according to the SLiM-CRAB-criterion ‘>1 focal lesion (FL) in MRI’. In this retrospective study, a baseline cohort of 147 SMM patients with wb-MRI at initial diagnosis was investigated, including prognostic data regarding development of CRAB-criteria. Fifty-two patients formed a follow-up cohort with a median of three wb-MRIs. The locations of all FLs were determined and it was calculated how staging decisions regarding the criterion ‘>1 FL in MRI’ would have been made if only a limited anatomic area (spine vs. spine plus pelvis) would have been covered by the MRI protocol. Furthermore, subgroups of patients selected by different cutoff-protocol-combinations were compared regarding their prognosis for development of CRAB-criteria. With an MRI protocol limited to spine/spine plus pelvis, only 28%/64% of patients who actually had >1 FL in wb-MRI would have been rated correctly as having ‘>1 FL in MRI’. Fifty-four percent/36% of patients with exactly 1 FL in spine/spine plus pelvis revealed >1 FL when the entire wb-MRI was analyzed. During follow-up, four more patients developed >1 FL in wb-MRI; both limited MRI protocols would have detected only one of these four patients as having >1 FL at the correct timepoint. Having >1 FL in spine/in spine plus pelvis/in the whole body was associated with a 43%/57%/49% probability of developing CRAB-criteria within 2 years. Patients with >3 FL in spine plus pelvis and patients with >4 FL in the whole body had an 80% probability to develop CRAB-criteria within 2 years. MRI protocols limited to the spine or to spine plus pelvis lead to substantial underdiagnoses of patients who actually have >1 FL in wb-MRI at baseline and during follow-up, which influences staging and treatment decisions according to the current SLiM-CRAB criteria. However, given the spatial distribution of FLs and the analysis on clinical course of patients indicates that the cutoff for the number of FLs should be adopted according to the MRI protocol when using MRI for staging in SMM.

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Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients

Diagnostics ◽

10.3390/diagnostics11061053 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1053

Author(s):

Davide Ippolito ◽

Teresa Giandola ◽

Cesare Maino ◽

Davide Gandola ◽

Maria Ragusi ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow Involvement ◽

Bone Lesion ◽

Diagnostic Value ◽

Lesion Detection ◽

Lower Limbs ◽

Whole Body ◽

Bone Lesions ◽

Whole Body Mri ◽

Mri Protocol

The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5–20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.

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Comparison of contrast-enhanced CT, dual-layer detector spectral CT, and whole-body MRI in suspected metastatic breast cancer: a prospective diagnostic accuracy study

European Radiology ◽

10.1007/s00330-021-08041-2 ◽

2021 ◽

Author(s):

Thomas Winther Buus ◽

Finn Rasmussen ◽

Hanne Marie Nellemann ◽

Vibeke Løgager ◽

Anders Bonde Jensen ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast ◽

Whole Body ◽

Diagnostic Accuracy Study ◽

Spectral Ct ◽

Whole Body Mri ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Accuracy Study

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Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Diagnostics ◽

10.3390/diagnostics11010118 ◽

2021 ◽

Vol 11 (1) ◽

pp. 118

Author(s):

Andreas S. Brendlin ◽

Moritz T. Winkelmann ◽

Phuong Linh Do ◽

Vincent Schwarze ◽

Felix Peisen ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Dose Reduction ◽

Whole Body ◽

Reference Standard ◽

Diagnostic Confidence ◽

Effective Radiation Dose ◽

Intraindividual Comparison ◽

Dual Source ◽

Effective Radiation

To evaluate the effect of radiation dose reduction on image quality and diagnostic confidence in contrast-enhanced whole-body computed tomography (WBCT) staging. We randomly selected March 2016 for retrospective inclusion of 18 consecutive patients (14 female, 60 ± 15 years) with clinically indicated WBCT staging on the same 3rd generation dual-source CT. Using low-dose simulations, we created data sets with 100, 80, 60, 40, and 20% of the original radiation dose. Each set was reconstructed using filtered back projection (FBP) and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 1–5, resulting in 540 datasets total. ADMIRE 2 was the reference standard for intraindividual comparison. The effective radiation dose was calculated using commercially available software. For comparison of objective image quality, noise assessments of subcutaneous adipose tissue regions were performed automatically using the software. Three radiologists blinded to the study evaluated image quality and diagnostic confidence independently on an equidistant 5-point Likert scale (1 = poor to 5 = excellent). At 100%, the effective radiation dose in our population was 13.3 ± 9.1 mSv. At 20% radiation dose, it was possible to obtain comparably low noise levels when using ADMIRE 5 (p = 1.000, r = 0.29). We identified ADMIRE 3 at 40% radiation dose (5.3 ± 3.6 mSv) as the lowest achievable radiation dose with image quality and diagnostic confidence equal to our reference standard (p = 1.000, r > 0.4). The inter-rater agreement for this result was almost perfect (ICC ≥ 0.958, 95% CI 0.909–0.983). On a 3rd generation scanner, it is feasible to maintain good subjective image quality, diagnostic confidence, and image noise in single-energy WBCT staging at dose levels as low as 40% of the original dose (5.3 ± 3.6 mSv), when using ADMIRE 3.

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NIMG-66. LONG-TERM FOLLOW-UP OF NEUROFIBROMATOSIS TYPE 1 PATIENTS USING WHOLE-BODY MRI DEMONSTRATES DYNAMIC CHANGES IN INTERNAL NEUROFIBROMA SIZE

Neuro-Oncology ◽

10.1093/neuonc/noz175.735 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi176-vi176

Author(s):

Ina Ly ◽

Raquel Thalheimer ◽

Wenli Cai ◽

Miriam Bredella ◽

Vanessa Merker ◽

...

Keyword(s):

Tumor Growth ◽

Neurofibromatosis Type 1 ◽

Neurofibromatosis Type ◽

Whole Body ◽

Childhood And Adolescence ◽

Entire Study ◽

Whole Body Mri

Abstract BACKGROUND Neurofibromas affect 40–50% of neurofibromatosis type 1 (NF1) patients and can cause significant morbidity and mortality. They grow more rapidly during childhood and adolescence but studies in adults are limited by their retrospective nature and follow-up time < 3 years. The long-term natural history of neurofibromas remains unknown. No guidelines exist on the need and frequency of surveillance imaging for patients. Whole-body MRI (WBMRI) can detect whole-body tumor burden, including internal neurofibromas. METHODS 17 adult NF1 patients who underwent WBMRI between 2007–2010 (Scan 1) underwent repeat WBMRI between 2018–2019 (Scan 2). Internal neurofibromas were segmented on short tau inversion recovery (STIR) sequences and tumor volume was calculated using a computerized volumetry and three-dimensional segmentation software. Circumscribed tumors were defined as discrete; invasive tumors or those involving multiple nerves were defined as plexiform. Tumor growth and shrinkage were defined as volume change ≥ 20% over the entire study period. RESULTS Median patient age was 43 years during Scan 1 and 53 years during Scan 2. Median time between Scan 1 and 2 was 9 years. A total of 140 neurofibromas were assessed. 24% of tumors grew by a median 63% (6.8% per year). 54% of tumors spontaneously decreased in volume by a median 60% (7% per year) without treatment. On a per-patient basis, 18% of patients had overall tumor growth and 41% overall tumor shrinkage. 8 new tumors developed in 7 patients. 16 tumors resolved entirely without medical or surgical intervention. Growth behavior did not correlate with discrete or plexiform morphology. CONCLUSION A subset of internal neurofibromas in adult NF1 patients grow significantly over a long-term period, suggesting that continued monitoring of these patients may be warranted. Surprisingly, more than half of neurofibromas shrink spontaneously without intervention. Continued patient enrollment and correlation of imaging findings with functional outcomes are underway.

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Evaluation of Shimming Techniques on MRI Breast Image Quality at 1.5T

Journal of Breast Imaging ◽

10.1093/jbi/wbz045 ◽

2019 ◽

Vol 1 (3) ◽

pp. 199-204

Author(s):

Wei Zhou ◽

Christopher P Favazza ◽

Jessica A Axmacher ◽

Joshua D Trzasko ◽

Jennifer R Geske ◽

...

Keyword(s):

Image Quality ◽

Statistical Significance ◽

Breast Mri ◽

Fat Saturation ◽

Institutional Review ◽

Breast Image ◽

Contrast Enhanced ◽

Preparatory Phase ◽

Clinical Mri

Abstract Objective The quality of all clinical MRI is dependent on B0 homogeneity, which is optimized during the shimming part of a prescan or preparatory phase before image acquisition. The purpose of this study was to assess shimming techniques clinically employed for breast MRI across our practice, and to determine factors that correlate with higher image quality for contrast-enhanced breast MRI at 1.5T. Methods One hundred consecutive female patients were retrospectively collected with Institutional Review Board approval. Shimming-related parameters, including shim-box placement and shimming gradient offsets were extracted from prior contrast-enhanced 3D fat-suppressed T1-weighted gradient echo image acquisitions. Three breast radiologists evaluated these images for fat saturation, breast density, overall image quality, and artifacts. Technologist experience was also evaluated for variability of shimming. Generalized linear mixed models were used to compare acquisition parameters between fat saturation. P < 0.05 was considered as statistical significance. Results The percentage of soft tissue inside the field of view (FOV) (ie, Tissue/FOV) in the good fat-saturation group (0.37 ± 0.06) was significantly lower (P < 0.01) than that in the poor fat-saturation group (0.39 ± 0.06). Other shimming-related parameters were found not significantly affecting the fat-saturation outcomes. Technologists with more experience tended to have less variable shimming performance than junior technologists did. Conclusions The quality of clinical MRI and especially breast MRI is highly dependent on shimming. Decreasing Tissue/FOV was associated with good image quality (good fat saturation). Optimization of shimming may require manual shimming or higher-order field-correction strategies.

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Detection of distant metastases in rectal cancer: contrast-enhanced CT vs whole body MRI

European Radiology ◽

10.1007/s00330-020-07149-1 ◽

2020 ◽

Vol 31 (1) ◽

pp. 104-111

Author(s):

Jeong Hee Yoon ◽

Mi Hye Yu ◽

Bo Yun Hur ◽

Chang Min Park ◽

Jeong Min Lee

Keyword(s):

Rectal Cancer ◽

Distant Metastases ◽

Whole Body ◽

Whole Body Mri ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

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Image quality in abdominal CT using an iodine contrast reduction algorithm employing patient size and weight and low kV CT technique

Acta Radiologica ◽

10.1177/0284185119898655 ◽

2020 ◽

Vol 61 (9) ◽

pp. 1186-1195

Author(s):

Veena R Iyer ◽

Eric C Ehman ◽

Ashish Khandelwal ◽

Michael L Wells ◽

Yong S Lee ◽

...

Keyword(s):

Image Quality ◽

Portal Vein ◽

Reduction Algorithm ◽

Diagnostic Confidence ◽

Abdominal Ct ◽

Contrast Dose ◽

Contrast Enhanced ◽

Tube Potential ◽

Patients At Risk ◽

Contrast Reduction

Background Low tube potential-high tube current computed tomography (CT) imaging allows reduction in iodine-based contrast dose and may extend the benefit of routine contrast-enhanced CT exams to patients at risk of nephrotoxicity. Purpose To determine the ability of an iodine contrast reduction algorithm to maintain diagnostic image quality for contrast-enhanced abdominal CT. Material and Methods CT exams with iodine contrast reduction were prescribed for patients at risk for renal dysfunction. The iodine contrast reduction algorithm combines weight-based contrast volume reduction with patient width-based low tube potential selection and bolus-tracking. Control exams with routine iodine dose were selected based on weight, width, and scan protocol. Three radiologists evaluated image quality and diagnostic confidence using a 4-point scale (<2 acceptable). Another radiologist assessed contrast reduction indications and measured portal vein and liver contrast-to-noise ratios. Results Forty-six contrast reduction algorithm and control exams were compared (mean creatinine 1.6 vs. 1.2 mg/dL, P ≤ 0.0001). Thirty-nine contrast reduction patients had an eGFR <60 mL/min/1.73m2 and 15 had single or transplanted kidney. Mean iodine contrast dose was lower in the contrast reduction group (20.9 vs. 39.4 g/mL, P < 0.0001). Diagnostic confidence was rated as acceptable in 95% (131/138) of contrast reduction and 100% of control exams (1.18–1.28 vs. 1.02–1.13, respectively; P > 0.06). Liver attenuation and contrast-to-noise ratio (CNR) were similar ( P = 0.08), but portal vein attenuation and CNR were lower with contrast-reduction (mean 176 vs. 198 HU, P = 0.02; 13 vs. 16, P = 0.0002). Conclusion This size-based contrast reduction algorithm using low kV and bolus tracking reduced iodine contrast dose by 50%, while achieving acceptable image quality in 95% of exams.

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