Diagnostic Performance of Whole-Body MRI as a Tool for Cancer Screening in Children With Genetic Cancer-Predisposing Conditions

Abstract

Unenhanced whole-body MRI is safe and produces excellent images. The high sensitivity, specificity, and NPV make whole-body MRI a valuable cancer screening tool in children with a genetic predisposition for cancer.

Pediatric Cancer Predisposition Imaging: Focus on Whole-Body MRI

“…Considerable site-to-site variations arise from differing scanner platforms and technological capabilities, the tumors and syndromes under surveillance, and departmental/radiologist preference. The most recent published protocols specific for WBMRI in pediatric oncology utilize a fluid-sensitive sequence in the coronal plane, with additional optional sequences and imaging planes (1,(6)(7)(8)(17)(18)(19), and are summarized in Table 2. As documented in the table, scan times vary significantly between protocols depending on number and type of sequences used.…”

“…One pediatric study by Nievelstein and Littooij compared WBMRI with PET/CT and found MRI was better able to identify bony infiltrates <12 mm (8). Although lung nodules are increasingly identified on WBMRIsome studies showing high sensitivities for lesions between 4 and 10 mm-WBMRI screening for pulmonary metastases is not yet advocated, and chest CT remains the reference standard (5,6 As well as a systematic approach and detailed knowledge improving lesion detection, as Anupindi and colleagues highlighted, it is equally important to carry out "risk stratification" to minimize false positive findings (18). WBMRI is only one part of a surveillance program, and findings should be interpreted in conjunction with other clinical and imaging data (17,18).…”

“…Although lung nodules are increasingly identified on WBMRIsome studies showing high sensitivities for lesions between 4 and 10 mm-WBMRI screening for pulmonary metastases is not yet advocated, and chest CT remains the reference standard (5,6 As well as a systematic approach and detailed knowledge improving lesion detection, as Anupindi and colleagues highlighted, it is equally important to carry out "risk stratification" to minimize false positive findings (18). WBMRI is only one part of a surveillance program, and findings should be interpreted in conjunction with other clinical and imaging data (17,18). Nonspecific findings with a low likelihood of being related to the syndrome in question can likely be managed conservatively in an otherwise asymptomatic patient rather than initiating a more intensive, and possibly invasive, diagnostic pathway.…”

“…Anupindi and colleagues (18) state that it is "imperative that the examinations be interpreted by radiologists who are familiar with whole-body MRI." This requires imaging specialists who are skilled both in the interpretation of WBMRI and knowledgeable about the CPS for which the screening examinations are being conducted in order to effectively conduct this risk assessment (18).…”

“…Anupindi and colleagues (18) state that it is "imperative that the examinations be interpreted by radiologists who are familiar with whole-body MRI." This requires imaging specialists who are skilled both in the interpretation of WBMRI and knowledgeable about the CPS for which the screening examinations are being conducted in order to effectively conduct this risk assessment (18). Options will vary at each site, depending upon specialist and subspecialist radiologist availability (e.g., one radiologist interpreting the entire exam versus a pediatric/body radiologist and neuroradiologist separately reporting respective anatomic regions), the volume of CPS WBMRI scans, as well as overall workload and workflow.…”