Research Presentation Session: Oncologic Imaging

RPS 516 - Whole-body MRI in oncology

February 28, 15:00 - 16:00 CET

7 min
Patients' selection for pelvic exenteration for gynaecologic neoplasm using whole-body MRI: preliminary results
Salvatore Persiani, Rome / Italy
Author Block: S. Persiani, G. Avesani, A. Perazzolo, L. D'Erme, C. Panico, V. Rufini, B. Gui, E. Sala; Rome/IT
Purpose: Pelvic exenteration is used to treat recurrent pelvic localisation in gynaecological patients. Critical patient selection is crucial due to high postoperative morbidity. Typically, patients undergo preoperative MRI to evaluate local disease extent and FDG-PET-CT to detect lymph nodes and distant metastasis. This study aims to evaluate whole-body-MRI (WB-MRI) in detecting extrapelvic disease in gynaecologic cancer patients awaiting pelvic exenteration and to test WB-MRI's reproducibility among radiologists.
Methods or Background: In this IRB-approved study from June 2021 to September 2023, patients with recurring gynaecological cancer prepped for pelvic exenteration underwent standard FDG-PET-CT, pelvic MRI, and additional sequences to assess extrapelvic disease, adding 20-25 minutes to the MRI exam time. Two radiologists reviewed WB-MRIs for extrapelvic involvement, comparing findings to FDG-PET-CT. Diagnostic accuracy and interradiologist agreement were evaluated.
Results or Findings: We included 36 patients. Seven patients had extra-pelvic localisations at PET-CT and were excluded from surgery. WB-MRI correctly identified six patients with extrapelvic involvement; the patient not identified had a PET-positive para-aortic lymph node with a short axis of 8mm. WB-MRI identified one patient with a suspicious peritoneal nodule, which was PET-negative and histologically defined as fibrotic area after surgery. The radiological PI showed a sensitivity of 0.85 (CI 0.42-0.99), specificity of 0.96 (CI 0.82-0.99), positive predictive value of 0.91 (CI 0.60-0.99) and negative predictive value of 0.94 (CI 0.72-0.97), with an overall accuracy of 0.93 (CI 0.80-0.99). The agreement between radiologists was 0.72.
Conclusion: WB-MRI has a good performance in detecting extrapelvic involvement in patients with gynaecologic malignancies and has good reproducibility; it may be considered a stand-alone technique for patient selection for pelvic exenteration for gynaecologic malignancies. However, these findings need to be confirmed in a larger sample.
Limitations: This was a monocentric study with a small sample size.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Fondazione Policlinico Gemelli Ethics Committee with reference number: 3813.
7 min
Performance comparison between whole body MRI and 18F-PSMA-1007 PET CT in the detection of tumour recurrence in prostate cancers
Margarita Garcia Fontes, Montevideo / Uruguay
Author Block: M. Garcia Fontes, E. Otero, L. Valuntas, V. Gigirey, J. Mattos, G. Dos Santos, J. P. Gambini, P. Duarte, O. Alonso; Montevideo/UY
Purpose: The aim of this study was to determine whether Whole Body Magnetic Resonance (WBMRI) with 3 Tesla offers similar performance to 18F-PSMA-1007 PET CT for recurrent tumour detection in prostate cancers.
Methods or Background: A WBMRI scan with a 3T GE equipment and a 18F-PSMA-1007 PET CT with a 64 GE PET -CT were performed in patients with prostate cancer and the suspicion of tumour recurrence. Thirty patients between 55 and 81 years old, with a PSA value between 0.4 and 41 ng/ml, were included. The number of bone lesions, suspicious nodes, local recurrences, and incidental findings with both methods were compared. The WBMRI study protocol was based on the METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P). An AXIAL T2 high Resolution and AXIAL DWI FOCUS sequences of the prostate were added to better the assessment of local tumour recurrence. Statistics analysis was performed.
Results or Findings: Both WBMRI and 18F-PSMA 1007 PET CT detected the same number of bone and lymph node metastases and local tumour recurrence. WBMRI found more bone lesions in two cases. Incidental findings revealed that both detected a neuroendocrine tumour in the right iliac fossa and the WBMRI detected a kidney tumour.
Conclusion: WBMRI seems to be an adequate method for the evaluation of tumour recurrences of prostate cancer with the advantages of greater accessibility, lower cost, and repeatability compared to PET CT18F-PSMA-1007. Further advantages include its lack of radiation and lack of contrast media usage.
Limitations: WBMRI requires patient collaboration due to its longer duration compared to PET CT PSMA, and some of these patients may be uncomfortable during the study. Biosafety limitations must also be considered. In order to validate the use of WBMRI in control of patients with prostate cancer recurrence, a larger series is necessary.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No information provided by the submitter.
7 min
Applying ONCO-RADS to whole-body MRI cancer screening in a retrospective cohort of asymptomatic subjects
Chung-Jung Lin, Taipei / Taiwan, Chinese Taipei
Author Block: C-J. Lin1, Y-S. Hu2, C-A. Wu1, H-J. Chiou1; 1Taipei/TW, 2New Taipei/TW
Purpose: The aim of this study was to evaluate the frequencies of cancer in asymptomatic subjects undergoing whole-body magnetic resonance imaging (WB-MRI) within the Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) categories.
Methods or Background: We retrospectively included 2064 asymptomatic subjects participating in the WB-MRI cancer screening program with a 3-T scanner between 2017 and 2022. Results of further investigations, including additional imaging and histopathology exams performed at our institute, were used to confirm cancer. Two radiologists blinded to the clinical outcome categorised the WB-MRI findings by using the ONCO–RADS categories as follows: 1 (normal), 2 (benign finding highly likely), 3 (benign finding likely), 4 (malignant finding likely), and 5 (malignant finding highly likely). Firth logistic regression analysis was conducted to determine the associations between the subject characteristics and findings of ONCO-RADS category ≥4.
Results or Findings: Of the 2064 subjects, 43 (2.1%) individuals had findings of ONCO-RADS category ≥4 and 24 (1.2%) had cancer confirmed. The cancer frequencies per subject were 0.1%, 5.4%, 42.9%, and 75% for ONCO-RADS category 2, 3, 4, and 5, respectively. In the multivariable model, older age (odds ratio (OR): 1.035, p=0.029), history of hypertension (OR: 2.051, p=0.026), hepatitis B carrier (OR: 2.584, p=0.013), and prior surgery (OR: 3.787, p<0.001) were independently associated with ONCO-RADS-category-≥4 findings.
Conclusion: The ONCO-RADS designed for cancer risk stratification was validated that higher numbers indicate greater likelihood of cancer. The application of ONCO-RADS facilitates risk-based management after WB-MRI for cancer screening.
Limitations: This was a retrospective study with contrast usage in the general population.
Funding for this study: Funding for this study was received with the code: MOST 112-2314-B-A49-064.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Taipei Veterans General Hospital Internal Review Board.
7 min
Predictive role of sustained imaging MRD negativity assessed by diffusion-weighted whole-body MRI in multiple myeloma
Barbara Frittoli, Brescia / Italy
Author Block: B. Frittoli, A. Belotti, T. Falcone, C. Saeli, S. Gambarini, R. Ambrosini, A. Tucci, L. Grazioli; Brescia/IT
Purpose: Diffusion-weighted whole-body magnetic resonance imaging (DW-MRI) is used in the management of multiple myeloma (MM) as part of the criteria for Response Assessment Category (RAC), as stated by the Myeloma Response Assessment and Diagnosis System
(MY-RADS). Its prognostic usefulness in the detection of minimal residual disease (MRD) after
autologous stem cell transplantation (ASCT) has been previously established. The goal of our study is to examine the predictive role of sustained imaging MRD-neg assessed by DW-MRI.
Methods or Background: DW-MRI and RAC criteria were performed in 70 MM patients, both after ASCT and at 1-year during maintenance therapy in order to evaluate imaging-residual-disease. We combined DW-MRI results with those of bone marrow samples, collected at day +100 after ASCT and at 1-year in MRD-neg patients.
Results or Findings: Multivariable analysis showed that progression free survival (PFS) and overall survival
(OS) were predicted by DW-MRI persistent disease (RAC≥2): p=0.001, HR 0.12 (95% CI:
0.05–0.30) for PFS, p=0.032, HR 0.20 (95% CI: 0.05–0.87) for OS. Median PFS was significantly
longer for patients with imaging MRD-neg at 1-year (RAC 1) compared to patients with residual disease on DW-MRI (RAC≥2) (median PFS: 55.4 vs. 28.4 months; 3-years PFS: 91% vs. 30%, respectively (HR 0.12; 95% CI: 0.04–0.35; p=0.0001)). OS of imaging MRD-neg patients at 1-year was significantly longer for patients with RAC1 vs. RAC≥2 (median OS: not reached (NR) vs. 63 months; 3-years OS: 100% vs. 82%, respectively (HR 0.13; 95% CI: 0.03–0.66; p=0.0007)).
Conclusion: Sustained imaging MRD negativity assessed by DW-MRI with RAC criteria has strong predictive relevance for survival in MM patients on maintenance therapy after ASCT. This work has also been published in a journal (well done) (doi: 10.1002/ajh.26995).
Limitations: The retrospective nature of observations and the relatively low number of patients represent major limitations of our study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study has been done in accordance with the Declaration of Helsinki. The submitter provided no additional information.
7 min
Potential added value of whole-body DWI-MRI in the diagnostic workup of patients with adenocarcinoma of unknown primary (ACUP): a prospective pilot study
Jeroen Willemse, Amsterdam / Netherlands
Author Block: J. Willemse, M. Lahaye, P. Snaebjornsson, S. Marchetti, M. Vollebergh, L. van Golen, W. Vogel, R. G. H. Beets-Tan, D. M. J. Lambregts; Amsterdam/NL
Purpose: The purpose of this prospective diagnostic pilot study was to investigate the potential added benefit of whole-body (chest-abdomen) MRI including DWI (further referred to as WB-MRI) in this diagnostic work-up of patients with adenocarcinoma of unknown primary (ACUP).
Methods or Background: From January 2022 to August 2023, the option of WB-MRI was added as an adjunct diagnostic tool to the routine clinical workup, including CT, FDG-PET/CT, lab tests, and biopsies for ACUP patients in our institution. The choice of whether to perform an MRI was discussed by a multidisciplinary team and guided by all available clinical information (e.g. if the primary tumour could likely be suspected to be located within the abdomen/pelvis). We analysed the impact of WB-MRI in terms of primary tumour identification and detection of additional metastatic sites.
Results or Findings: WB-MRI was performed in 27 ACUP patients. In 6/27 (22%) of patients, WB-MRI suggested a possible primary tumour location undiagnosed on previous CT and/or FDG-PET/CT, including 2 bile duct cancers, 1 ovarian, 1 appendiceal, 1 duodenal and 1 pancreatic cancer. In 5 of these 6 cases, the WB-MRI diagnosis aligned with and supported the final diagnosis, established by integration of clinicopathological data with whole genome sequencing. In addition, WB-MRI discovered extra metastatic sites in 6/27 (22%) of patients, including peritoneal metastases (n=3), bone (n=1), kidney (n=1) and testicular metastases (n=1).
Conclusion: This study demonstrates the potential added value of WB-MRI in the search for the underlying primary tumour in the complex diagnostic work-up of patients with disseminated adenocarcinoma of unknown primary.
Limitations: This was a small pilot study with a correspondingly small cohort.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This was a retrospective analysis of data acquired prospectively as part of routine clinical care, approved by the local Institutional Research Board.
7 min
The impact of whole-body MRI for staging unfavourable intermediate- and high-risk prostate cancer prior to curative-intent surgery, radiotherapy, hormonal therapy: all-in-one MRI preliminary data
Cristiano Michele Girlando, Milan / Italy
Author Block: C. M. Girlando1, S. Alessi1, Y. Zambanini1, S. Luzzago1, B. Frittoli2, S. Gambarini2, L. Grazioli2, G. Petralia1; 1Milan/IT, 2Brescia/IT
Purpose: This is a multicentric, prospective interventional study, with the aim of comparing the accuracy of Whole-Body Magnetic Resonance Imaging (WB-MRI) with that of conventional imaging (Computed Tomography and Bone Scintigraphy) for the systemic staging of patients with unfavourable intermediate- or high-risk prostate cancer (PCa) and how WB-MRI staging results affect the treatment decision.
Methods or Background: In two IRCCS centres, patients with unfavourable intermediate- or high-risk PCa were enrolled and underwent systemic staging with conventional imaging and WB-MRI. Staging examinations were reported blinded to each other. A first systemic staging and treatment decision was made by the multi-disciplinary team based on conventional imaging staging only and, after the outcome of the WB-MRI, was formulated the definitive therapeutic proposal based on all available test results. We compared the diagnostic accuracy of WB-MRI staging with that of conventional imaging staging and reported how WB-MRI staging resulted in changes in treatment decision.
Results or Findings: This is a preliminary evaluation based on the first 80 subjects enrolled. Of these, 2 were excluded due to drop-out. In the remaining 78 patients WB-MRI, compared to conventional imaging, led to an upstage in 19 patients (24.4%) and to a downstage in 9 patients (11.5%), leading to a change in the therapeutic proposal in 17 patients (21.8%).
Conclusion: WB-MRI has shown superior diagnostic accuracy compared to conventional imaging in the systemic staging of patients with unfavourable intermediate- or high-risk PCa with better risk stratification and more appropriate treatment proposals.
Limitations: No limitations were identified.
Funding for this study: Funding was received from the Italian Ministry of Health with Ricerca Corrente and 5x1000 funds.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Institutional Ethics Committee (UID 2080), and all patients provided informed consent for their participation in the study in addition to that for the individual radiological procedures.
7 min
Whole-body MRI in staging of diffuse large B-cell lymphoma
Monika Wagnerová, Praha / Czechia
Author Block: M. Wagnerová, P. Vodicka, K. Benesova, A. Bocan, D. Zogala, A. Burgetova, M. Trneny, L. Lambert; Prague/CZ
Purpose: In this study, we evaluated the diagnostic performance of whole body magnetic resonance imaging (wbMRI) in the staging of diffuse large B-cell lymphoma and patients' preference for the staging modality.
Methods or Background: In this single-centre prospective study, adult patients diagnosed with DLBCL underwent wbMRI and 18-F FDG PET/CT as the reference standard. Two radiologists evaluated wbMRI for nodal (12 nodal regions) and extranodal involvement. Patients received a questionnaire about wbMRI.
Results or Findings: 14 of 78 patients consented to participate in and complete the study. The sensitivity and specificity of wbMRI in the assessment of nodal involvement was 0.84 and 1.00. Extranodal involvement was apparent in all 14 instances. Staging was concordant with PET/CT in all patients. The most frequent concern was the fear of an enclosed environment and the duration of the examination.
Conclusion: Despite excellent sensitivity and specificity of wbMRI in staging of DLBCL, wbMRI is preferred less by the patients due to the fear of an enclosed environment and the duration of the examination.
Limitations: There was a low number of patients willing to participate, and no evaluation of treatment response.
Funding for this study: Funding for this study was received from the Czech Ministry of Health (MH CZ-DRO, General University Hospital in Prague - VFN, 00064165; VES NU21-03-00411) and from institutional funding at the Charles University in Prague (Cooperatio, Medical Diagnostics and Basic Medical Sciences and Haematology-Oncology).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethics Committee of the General University Hospital in Prague (12/20 Grant VFN IGP).

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