Feasibility of whole-body diffusion-weighted MRI for detection of primary tumour, nodal and distant metastases in women with cancer during pregnancy: a pilot study
To evaluate the feasibility of whole-body diffusion-weighted MRI (WB-DWI/MRI) for detecting primary tumour, nodal and distant metastases in pregnant women with cancer.
Twenty pregnant patients underwent WB-DWI/MRI in additional to conventional imaging. Reproducibility of WB-DWI/MRI between two readers was evaluated using Cohen’s κ statistics and accuracy was compared to conventional imaging for assessing primary tumour site, nodal and visceral metastases.
Both WB-DWI/MRI readers showed good–very good agreement for lesion detection (primary lesions: κ=1; lymph nodes: κ=0.89; distant metastases: κ=0.61). Eight (40 %) patients were upstaged after WB-DWI/MRI. For nodal metastases, WB-DWI/MRI showed 100 % (95 % CI: 83.2–100) sensitivity for both readers with specificity of 99.4 % (96.9–100) and 100 % (80.5–100) for readers 1 and 2, respectively. For distant metastases, WB-DWI/MRI showed 66.7 % (9.4–99.2) and 100 % (29.2–100) sensitivity and specificity of 94.1 % (71.3–99.9) and 100 % (80.5–100) for readers 1 and 2, respectively. Conventional imaging showed sensitivity of 50 % (27.2-72.8) and 33.3 % (0.8–90.6); specificity of 100 % (98–100) and 100 % (80.5–100), for nodal and distant metastases respectively.
WB-DWI/MRI is feasible for single-step non-invasive staging of cancer during pregnancy with additional value for conventional imaging procedures.
• In our study, WB-DWI/MRI was more accurate than conventional imaging during pregnancy.
• WB-DWI/MRI improves diagnostic assessment of patients with cancer during pregnancy.
• Accurate imaging and oncologic staging improves treatment and outcome.
KeywordsMagnetic resonance imaging Diffusion magnetic resonance imaging Cancer Pregnancy Staging
This study has received funding by Research Fund Flanders (F.W.O.). Supported by grants from the Belgian Cancer Plan (Ministry of Health), Stichting tegen Kanker and the CRADLE project supported by the European Research Council.
Compliance with ethical standards
The scientific guarantor of this publication is Vincent Vandecaveye.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise (Steffen Fieuws).
Institutional Review Board approval was obtained.
Written informed consent was obtained from all subjects (patients) in this study.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in a poster presentation at the International Cancer Imaging Society in London, UK in 2015. The abstract was published as:
Dresen RC, Han SN, Michielsen K, De Keyzer F, Gziri MM, Amant F, Vandecaveye V (2015) Whole-body diffusion-weighted MRI for staging of women with cancer during pregnancy: a pilot study. Cancer imaging15 (Suppl 1):P50.
• diagnostic or prognostic study
• performed at one institution
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