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10:07 CET
SA 5a - Whole-body MRI: ready for prime time?
Imaging Methods
Thursday, March 1, 08:30 - 10:00
Room: Studio 2018
Moderator: F. E. Lecouvet (Brussels/BE)

Chairperson's introduction
F. E. Lecouvet; Brussels/BE
Learning Objectives

1. To become aware of the feasibility of whole-body MRI.
2. To learn about its roles: detect, monitor and provide prognostic information.
3. To understand the anatomic targets: bone and beyond.
4. To become familiar with current developments in the technique and their implementation.


WB-MRI is now a commonly applied modality for bone screening for “osteophilic” metastatic cancers, lymphomas, and multiple myeloma and can also assess visceral and nodal involvement. WB-MRI’s applications have been expanded to other fields, mainly in rheumatology; it has shown promise for diagnosis and evaluation of treatment response of spondyloarthropathies, and many muscle, bone, neurological, and vascular disorders. The diversity of indications is reflected by the segmentation of this session: the different medical fields where WB-MRI contributes to improvement in patient care will be addressed by expert speakers from varied geographical origins who will share their respective experience. They will Illustrate imaging findings, provide technical recommendations, and describe the place oft he technique amongst others in modern management of diseases.

The case of metastatic bone disease
A. R. Padhani; London/GB
Learning Objectives

1. To understand the clinical rationale for the use of whole-body MRI when evaluating metastatic disease.
2. To learn about the use of METRADS data acquisition and response assessment guidelines.
3. To become aware of the potential benefits of whole-body tumour load quantification.
4. To review examples of clinical pathway benefits, including precision medicine approaches.


WB-MRI will replace current, ineffective & indirect methods of malignant disease detection in the bone marrow with applications in myeloma, breast, and prostate cancer. Multiple imaging standards are published including the MET-RADS system which will be summarised. WB-MRI has the potential to alter diagnostic thinking when assessing bone response: by adding new categories that positively assess the success of therapies in bone disease (NOT just absence of progression). It is unclear whether this will allow patients to live better for longer?. WB-MRI can help deliver the promise of high precision medicine for patients with metastatic bone disease.

The case of multiple myeloma
L.-A. Moulopoulos; Athens/GR
Learning Objectives

1. To become aware of the value of whole-body MRI in myeloma.
2. To learn about its roles: detect, monitor and provide prognostic information.
3. To understand current imaging protocols.


WBMRI is more sensitive than WBXR and WBCT for the early detection of bone marrow involvement in multiple myeloma and it performs better than PET-CT in the diagnosis of small lesions or diffuse bone marrow infiltration. In the updated (2014) international myeloma working group (IMWG) criteria for the definition of myeloma, MRI is considered a biomarker of malignancy, with the presence of more than one focal lesion on MRI establishing the diagnosis of symptomatic disease. When MRI of the spine and pelvis is performed, an approximately 10% false negative rate may be observed because of focal lesions located exclusively in the appendicular skeleton. WBMRI, on the other hand, provides a means of bone marrow tumour burden assessment and at the same time identifies possible extraskeletal locations of myeloma. Bone marrow patterns of involvement and tumour burden on WBMRI have also emerged as important tools for prognosis. Regarding assessment of response to therapy, even though PET-CT is currently the preferred modality for optimal definition of a complete response to treatment in patients with myeloma, ADC values extracted from DWI images, have been shown to change early after treatment, suggesting a possible role for WBDWI in the evaluation and prediction of successful therapy. In the era of novel therapies for multiple myeloma, the role of a non-ionizing imaging modality like WBMRI for the search of minimal residual disease in the bone marrow and extraskeletal sites of disease at the same time, is appealing and warrants further investigation.

The case of lymphoma
M. E. Mayerhöfer; Vienna/AT
Learning Objectives

1. To become aware of the role of whole-body MRI for imaging lymphoma subtypes.
2. To learn about its roles: detect, monitor and provide prognostic information.
3. To understand the current limitations of whole-body DWI.


Lymphomas are a heterogeneous group of hematological malignancies that can be roughly divided into Hodgkin (HL) and non-Hodgkin (NHL) lymphomas, and account for about 5% of all cases of cancer. The NHL group is characterized by a high level of heterogeneity between the different subtypes, not only with regard to their histological features, but also with regard to growth rates and clinical course/prognosis, as well as treatment options. Nevertheless, the majority of lymphomas show a high cell density, which makes them an attractive target for diffusion-weighted imaging (DWI), because of the associated compression of extracellular space. Even though [18F]FDG-PET/CT is generally regarded as the technique of choice for imaging of lymphomas (and in particular, for assessment of treatment response), there are several justifications for the use of whole-body DWI in lymphoma patients. For instance, the fact that some lymphoma subtypes (such as HL) are common in children and adolescents makes DWI attractive due to its lack of exposure to ionizing radiation, which is relevant because these patients may require life-long follow-up. In addition, slowly growing NHL subtypes such MALT lymphoma frequently show low, or no, FDG uptake, whereas they still show the diffusion restriction pattern on DWI, due to their high cell density. Finally, access to MRI, and thus, also to DWI, is far easier than to [18F]FDG-PET/CT due to the relative abundance of MR scanners, which may decrease waiting intervals and lead to earlier treatment initiation. Nevertheless, while several studies have shown that whole-body DWI is only slightly to moderately inferior to [18F]FDG-PET/CT, DWI is still limited with regard to the evaluation of small lymph nodes, the assessment of diffuse bone marrow involvement, and, mainly due to motion artifacts, for lesion assessment in the lower neck and the mediastinum.

Beyond oncology: rheumatology and more
S. Weckbach; Heidelberg/DE
Learning Objectives

1. To become aware of the protocols and diagnostic value of whole-body MRI in rheumatological and neuromuscular disorders.
2. To understand the role of whole-body MRI screening for multi-site inflammation in one single examination.
3. To learn about its role in differential diagnosis quantification of disease burden and assessment of therapeutic response.


The high soft tissue contrast and anatomical resolution of whole body MI (WBMRI) in combination with an excellent sensitivity and specificity for the musculoskeletal system offer many advantages in the diagnostic process of rheumatological and neuromuscular disorders. Disease specific adaption of different protocol modules allow the replacement of multiple separate exams by one whole-body MRI (WB-MRI) examination so that WB-MRI is capable of a combined visualisation of the spine and all relevant joints, the vessel system and potentially affected organs such as the brain, the kidneys or the heart in only one exam. It is able to directly and simultaneously show (even subtle) active and chronic inflammation including synovial, cartilaginous and bony changes. It is very well suited for the visualisation of enthesitis and arthritis in central and peripheral joints at one examination. Moreover, WB-MRI allows the early detection of bone marrow changes and muscle pathologies. Therefore, it holds the potential to estimate the total disease load and disease activity of different rheumatological and neuromuscular disorders as well as follow-up patients under therapy. Due to the exact localization of inflammatory processes present at multiple sites and visualisation of typical disease pattern, it enables us to distinguish between a variety of rheumatological and neuromuscular disorders.

Panel discussion: Whole-body MRI: when, how and why should you do it?
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