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This study was undertaken to assess the utility of whole‐body turbo short tau inversion recovery (STIR) magnetic resonance imaging (MRI) to detect metastases to liver, brain, and bone as a single examination in women with breast cancer. Seventeen patients with biopsy‐proven breast cancer and suspected metastatic disease attending over a 12‐month period referred for both conventional imaging and whole‐body MRI were included in the study. Three patients were found to be free of metastases at both conventional and MR imaging. Appendicular or axial skeletal metastases were identified in 11 of 17 patients, with correlation between findings at whole‐body MRI and scintigraphy in 15 of the 17 patients. Five patients had evidence of hepatic metastases on whole‐body MRI, of which metastases were identified in only three patients at CT despite contrast enhancement. Four patients had brain abnormalities (metastases in three patients, meningioma in one patient) detected on both whole‐body and dedicated brain MRI. Preliminary clinical experience suggests that turbo STIR whole‐body MRI may represent a convenient and cost‐effective method of total body screening for metastases in patients with breast carcinoma. J. Magn. Reson. Imaging 2000;11:343–350. © 2000 Wiley‐Liss, Inc.

Our evaluation of discrepancy rates was unusual in that we included interpretations of sonograms, on which residents and the attending radiologist had a higher rate of agreement (99.5%). Because of the high agreement in the interpretation of sonograms, the overall discrepancy rate was 3.8%. However, if only body CT scan interpretations were evaluated, our results were closer to the rates reported in previously published studies. Major discrepancies led to a change in patient treatment but did not lead to any increase in patient morbidity or to any quantifiable increase in the length of the hospital stay.

Despite expert reader analyses, subjective evaluations of liver lesion signal characteristics are prone to inaccuracy and lack certainty and consistency when intermediate TEs (50/160 ms) are used. Quantitative measurements of T2 relaxation times should be performed to accurately and confidently differentiate benign from malignant liver lesions. Use of a higher T2 threshold than previously recommended is required to avoid misclassification of malignancies.

This brief report outlines the novel use of whole body coronal turbo short tau inversion recovery (STIR) imaging to localize a primary tumor in patients with known metastatic disease without a previously identified source. ATTEMPTS TO IDENTIFY the source of metastases in patients without a known primary tumor are often time consuming, expensive, and ultimately unsuccessful (1). We report the novel use of whole body turbo short tau inversion recovery (STIR) MRI, as a n alternative to radiographs, CT, and scintigraphy, to identify the source of skeletal metastases in patients without a previously recognized primary source. METHODS AND MATERIALSOf 60 patients referred for staging whole body turbo STIR MRI over an 18-month period. 56 patients had known primary tumors. Four patients with documented metastatic disease (skeletal metastases, three patients: retroperitoneal lymphadenopathy, one patient), were referred without a known primary tumor. In each case, review of chest radiograph and abdominal CT failed to identify a primary tumor before whole body turbo STIR MRI. MR TechniqueMRI was performed on a 1.5-T Philips Gyrosran imager (Philips Medical Systems, Shelton, CT). In each case, coronal images were acquired using the body coil, maximum field of view (45-50 cm), and a turbo STIR sequence (TR = 4,000 msec: TE = 40 msec, inversion time [TI] = 160 msec: echo train length [ETL] = 6; echo spacing = 12 msec: acquisition time = 3 minutrs 43 seconds [images of the thorax were respiratory gated, increasing acquisition lo a n average of 8 minutes]), allowing uniform fat saturation and enhanced conspicuity of skeletal, visceral, and soft tissue lesions. In each case, 16 coronal slices were acquired for a TR of 4,000-msec, slice thickness dictated by body habitus (mean, 8 mm: with an interslice gap of .5 mm), and complete body coverage achieved by a maximum of four overlapping coronal body coil acquisitions (mean total scan time, 40 minutes). In each case, coronal images were obliqued to the long axis of the spine prescribed off a sagittal localizrr. In each case, positioning of the upper extremities was dictated by patient habitus. In patients with cachexia, the arms were easily placed over the thorax and abdomen. In larger patients, the arms were placed above the head, requiring an additional coronal acquisition (an additional 4 minutes scan time). RESULTS Case 1A 42-year-old male presented with shoulder pain. A chest radiograph dem-

We recommend using the combination of T2 quantification and patient history of malignancy before deciding to administer gadopentetate dimeglumine for optimal lesion characterization, especially for equivocal lesions with T2 values between 90 and 130 msec. These factors allowed the construction of a prediction rule for lesion characterization.

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The ability to evaluate renal artery and adrenal anatomy globally can be useful, as exemplified in the current series, and the adrenals should be examined carefully in any renal MR in a hypertensive patient.