Multiparametric bone MRI can improve CT-guided bone biopsy target selection in cancer patients and increase diagnostic yield and feasibility of next-generation tumour sequencing

Abstract

Objectives To evaluate whether multiparametric bone MRI (mpBMRI) utilising a combination of DWI signal, ADC and relative fat-fraction (rFF) can identify bone metastases, which provide high diagnostic biopsy yield and next-generation genomic sequencing (NGS) feasibility. Methods A total of 150 CT-guided bone biopsies performed by interventional radiologists (3/2013 to 2/2021) at our centre were reviewed. In 43 patients, contemporaneous DWI and rFF images, calculated from 2-point T1w Dixon MRI, were available. For each biopsied lesion, a region of interest (ROI) was delineated on ADC and rFF images and the following MRI parameters were recorded: visual classification of DWI signal intensity (SI), mean, median, 10th and 90th centile ADC and rFF values. Non-parametric tests were used to compare values between tumour positive/negative biopsies and feasible/non-feasible NGS, with p-values < 0.05 deemed significant. Results The mpBMRI combination high DWI signal, mean ADC < 1100 µm2/s and mean rFF < 20% identified tumour-positive biopsies with 82% sensitivity, 80% specificity, a positive predictive value (PPV) of 93% (p = 0.001) and NGS feasibility with 91% sensitivity, 78% specificity and 91% PPV (p < 0.001). The single MRI parameters DWI signal, ADC and rFF failed to distinguish between tumour-positive and tumour-negative biopsies (each p > 0.082). In NGS feasible biopsies, mean and 90th centile rFF were significantly smaller (each p < 0.041). Single ADC parameters did not show significant difference regarding NGS feasibility (each p > 0.292). Conclusions MpBMRI utilising the combination of DWI signal, ADC and rFF can identify active bone metastases, which provide biopsy tissue with high diagnostic yield and NGS feasibility. Key Points • Multiparametric bone MRI with diffusion-weighted and relative fat-fraction images helps to identify active bone metastases suitable for CT-guided biopsy. • Target lesions for CT-guided bone biopsies in cancer patients can be chosen with greater confidence. • CT-guided bone biopsy success rates, especially yielding sufficient viable tissue for advanced molecular tissue analyses, can be improved.

Diffusion-Weighted MRI for Treatment Response Assessment in Osteoblastic Metastases—A Repeatability Study

“…Donners et al assessed the value of multiparametric MRI to identify viable bone metastases for biopsies. In their sample of 43 lesions, they observed lower, though not statistically significant, mean/median ADC in tumor-positive biopsies [41]. In contrast to the studies by Reischauer et al [40], Messiou et al [28] and Donners et al [41], which employed regions of interest (ROI), we used volume of interests (VOIs).…”

“…In their sample of 43 lesions, they observed lower, though not statistically significant, mean/median ADC in tumor-positive biopsies [41]. In contrast to the studies by Reischauer et al [40], Messiou et al [28] and Donners et al [41], which employed regions of interest (ROI), we used volume of interests (VOIs). Going beyond previous studies, the validity of ADC measurements were ensured in our study by the use of a phantom containing the complete range of measured values found in vivo.…”

Developing and testing a robotic MRI/CT fusion biopsy technique using a purpose-built interventional phantom

“…We also advise taking a stepwise approach, where relatively fixed tumours are first investigated ( e.g. , MRI-guided bone biopsy [ 22 , 23 ], followed by more mobile tumours using internal motion correction techniques as has been applied in robotic lung biopsy without image fusion using breath hold monitoring [ 24 ]. For example, whereas rigid registration (as used in our study) might be more suitable for non-deformable structures with fixed internal points ( e.g.…”

“…Clinical translation should include the addition of a vacuum immobilisation mattress to reduce external motion [21]. We also advise taking a stepwise approach, where relatively fixed tumours are first investigated (e.g., MRI-guided bone biopsy [22,23], followed by more mobile tumours using internal motion correction techniques as has been applied in robotic lung biopsy without image fusion using breath hold monitoring [24]. For example, whereas rigid registration (as used in our study) might be more suitable for non-deformable structures with fixed internal points (e.g., bone), deformable structures may benefit from more complex deformable registration algorithms [25].…”

Potential biomarkers for the early detection of bone metastases

“…positron emission computed tomography PET has a high positive rate, but it doesn’t applicable to simple bone lesions, and the price is relatively high, which limited its application in clinic ( 11 , 12 ). Theoretically, the changes of biochemical indexes of bone metabolism during bone metastases are earlier than those in imaging ( 13 , 14 ). However, traditional biochemical indexes of bone metabolism with low specificity limits their application in the study of bone metastases ( 15 , 16 ).…”