Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging

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.

3D MRI in Musculoskeletal Oncology

“…WB-MRI is increasingly used in screening for and characterization of MSK malignancy, as well as in tumor syndromes and marrow disorders. 19,23 Acquisition utilizing 3D techniques facilitates the acquisition of WB-MRI in a reasonable time period, as discussed previously. With regard to diagnostic performance, VIBE and WB-DWI were shown to be feasible and useful in the characterization of peripheral nerve tumors.…”

Magnetic Resonance Imaging Biomarkers of Bone and Soft Tissue Tumors

“…Whole-body (WB)-MRI with DWI can help detect bone marrow malignancies including multiple myeloma and metastatic disease and soft tissue neoplasms. 89,90 Sun et al showed the efficacy of WB-MRI with DWI in differentiating the various bone marrow infiltration patterns of monoclonal plasma cell diseases and also reported the association of ADC values with serum β2-microglobulin levels (indicator of tumor burden) in different bone marrow infiltration patterns among myeloma patients. 91,92 WB-MRI with DWI sequences has further shown diagnostic merit to evaluate treatment response in multiple myeloma patients, without the use of intravenous contrast.…”

Tumors of the Spine: When Can Biopsy Be Avoided?

“…In our practice, MRI is performed in all patients to assess the response to the intervention and/or plan further treatments. 18,30,31 In addition to MRI, to merely estimate the response to therapy and to detect progression or local or distant recurrence early on, hybrid imaging techniques, such as positron emission tomography (PET)/CT and PET/MRI, are sufficient and highly specific for this purpose. 31 Primary tumors of the spine, for instance, giant cell tumors, chordoma, chondrosarcoma, and osteosarcoma (►Fig.…”

“…18,30,31 In addition to MRI, to merely estimate the response to therapy and to detect progression or local or distant recurrence early on, hybrid imaging techniques, such as positron emission tomography (PET)/CT and PET/MRI, are sufficient and highly specific for this purpose. 31 Primary tumors of the spine, for instance, giant cell tumors, chordoma, chondrosarcoma, and osteosarcoma (►Fig. 8), are uncommon and represent < 5% of all bone neoplasms when compared with secondary metastatic disease, multiple myeloma, and lymphoma.…”

“…In our practice, MRI is performed in all patients to assess the response to the intervention and/or plan further treatments. 18 30 31 In addition to MRI, to merely estimate the response to therapy and to detect progression or local or distant recurrence early on, hybrid imaging techniques, such as positron emission tomography (PET)/CT and PET/MRI, are sufficient and highly specific for this purpose. 31…”