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Whole-body MRI: a powerful alternative to bone scan for bone marrow staging without radiation and gadolinium enhancer

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Abstract

Purpose

Whole-body magnetic resonance imaging (WB-MRI) is a radiation-free alternative to the 99mTc-HDP bone scan (BS) for the detection of bone metastasis. The major drawback is the long examination time and application of gadolinium enhancer. The aim of this study is to analyze (i) the performance of WB-MRI versus the BS and (ii) the diagnostic benefit of gadolinium (WB-MRI + Gd) compared to a non-enhanced protocol (NE WB-MRI).

Methods and materials

1256 eligible WB-MRI scans were analyzed retrospectively with a single inclusion criterion, a clinical 12-month follow-up or a biopsy as ground truth. N = 285 patients received both a WB-MRI and a BS within 12 months. All the patients were imaged with a coronal T1w and a STIR, and n = 528 (42%) received an additional T1w-mDixon with gadoteridol (0.1 mmol Gd-DTPA/kg).

Results

From 1256 eligible patients, n = 884 (70%) had breast cancer as a primary disease, n = 101(8%) prostate cancer, and n = 77(6%) lung cancer. The sensitivity (Se) and negative predictive value (NPV) of the WB-MRI was 98/99%, significantly higher compared to BS with 82/89%, P < 0.001 Mc Nemar’s test. The specificity (Spe) and positive predictive value (PPV) of the WB-MRI and BS was 85/82% and 91/86%, respectively. The interobserver agreement between WB-MRI and BS was 71%, Cohen’s kappa 0.42. Analysis of the added diagnostic value of gadolinium revealed Se/Spe/PPV/NPV of 98/93/92/98% for the NE WB-MRI and 99/93/85/100% for the WM-MRI + Gd, P > 0.05 binary logistic regression with Fischer’s exact test.

Conclusion

WB-MRI exceeds the sensitivity of BS without compromising the specificity, even after omitting the gadolinium enhancer.

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Abbreviations

1.5 T:

1.5 Tesla

3 T:

3 Tesla

18F-FDG PET/CT:

2-Deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography

BS:

Bone scan, 99mTc-hydrohydiphosphonate bone scintigraphy

CI:

Confidence interval

FFE:

Fast field echo

MRI:

Magnetic resonance imaging

NE WB-MRI:

Non-enhanced whole body MRI

NPV:

Negative predictive value

PPV:

Positive predictive value

Se:

Sensitivity

Spe:

Specificity

STIR:

Short tau inversion recovery

T1w:

T1-weighted imaging

TSE:

Time spin echo

WB-MRI:

Whole body MRI

WB-MRI + Gd:

Whole body MRI with gadoteridol

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Acknowledgements

The authors are thankful to Mr. Stefan Stein and Mr. Sven Winzler for excellent and consequent IT support. Mrs. Gabriele Kaps leaded the group of radiographers that guaranteed the seamless and flawless MRI workflow. Finally, special accreditation goes to Mrs. Ines Lischka for her proficiency in MRI and her tireless dedication in daily problem-tackling.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital of Jena, Jena, Germany

    I. Papageorgiou & U. Teichgraeber

  2. Institute of Radiology, Suedharz Hospital Nordhausen, 39 Dr.-Robert-Koch Street, 99734, Nordhausen, Germany

    I. Papageorgiou, I. Cosma & A. Malich

  3. Department of Nuclear Medicine, Suedharz Hospital Nordhausen, Nordhausen, Germany

    J. Dvorak

  4. Department of Internal Medicine, University Hospital of Jena, Jena, Germany

    A. Pfeil

Authors
  1. I. Papageorgiou
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  6. A. Malich
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Contributions

AM and IP conceived and design the study, IP, JD, IC and AM acquired and interpreted data, IP, IC and AP analyzed and interpreted data. All authors participated in drafting the article, AM an UT revised the article critically for important intellectual content. All authors approved the final manuscript version to be published.

Corresponding author

Correspondence to I. Papageorgiou.

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Conflicts of interest

Authors declare no conflicts of interest in the manuscript, including financial, consultant, institutional and other relationships that might lead to bias.

Ethical approval

All the patient data were derived from the database of our institution. Data were analyzed retrospectively, fully anonymized, in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its amendments, the European regulation 536/2014 and its latest addendum ICH GCP E6(R2)/2017, as well as with the guidelines of the local Institutional Review Board for clinical studies (Ref. number 2019-1288).

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Papageorgiou, I., Dvorak, J., Cosma, I. et al. Whole-body MRI: a powerful alternative to bone scan for bone marrow staging without radiation and gadolinium enhancer. Clin Transl Oncol 22, 1321–1328 (2020). https://doi.org/10.1007/s12094-019-02257-x

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  • DOI: https://doi.org/10.1007/s12094-019-02257-x

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