The Role of Whole-Body MRI in Pediatric Oncology

Abstract

Pediatric whole-body (WB) magnetic resonance imaging (MRI) is an established technique that, with improved accessibility and advances in technology, is being used with increasing frequency for a wide variety of applications. The advantages of WB MRI (over other imaging modalities), particularly its lack of ionizing radiation (of particular concern in pediatric imaging due to children's increased sensitivity to ionizing radiation) and the ability of MRI to image the bone marrow, solid organs, and soft tissues with superior soft-tissue contrast resolution to other techniques, promise that WB MRI has great potential in conditions that are diffuse or multifocal. There is particular interest in its role in the field of pediatric oncology (eg, lymphoma, neuroblastoma, sarcoma, and Langerhans cell histiocytosis). The main disadvantages of WB MRI are its relatively long scanning times, artifacts from motion (requiring patient cooperation or general anesthesia), and limited specificity. However, advances in hardware and imaging techniques, including additional sequences (out-of-phase imaging, diffusion-weighted imaging, and contrast enhancement) are reducing the impact of some of these challenges.

2017 GPOH Guidelines for Diagnosis and Treatment of Patients with Neuroblastic Tumors

“…All sites involved at diagnosis must be re-assessed at regular intervals during treatment und follow-up. Although prospective trials comparing whole body MRI, 123 I-mIBG SPECT, 18 F-FDG PET-CT, and bone marrow cytology are limited to date [4,65,85,174], whole-body MRI is increasingly being used in order to detect distant metastases. General anesthesia might be required for MRI in young children.…”

Positron Emission Tomography/Magnetic Resonance Imaging Applications in Pediatric Imaging

“…Pediatrik hastalarda radyasyon maruziyetini azaltmak üzere son yıllarda birçok farklı araştırmacı FDG PET yerine tüm vücut manyetik rezonans görüntüleme (MRG) kullanmayı denemiştir; ancak MRG tek başına FDG PET'in tanısal doğruluğuna ulaşamamıştır (6). Halen farklı MRG sekansları ve çeşitli kontrast maddeler ile pediatrik onkolojide FDG PET yerine tüm vücut MRG kullanımı artırılmaya çalışılmaktadır (7).…”

Pediatric whole‐body MRI: A review of current imaging techniques and clinical applications

“…Given its applicability in visualization of multifocal and widespread disease processes, one of the more common applications of whole‐body MRI is in the oncology setting. Utility has been shown in staging already diagnosed malignancies as well as screening in patients with genetic cancer predispositions . In various trials, including the American College of Radiology Imaging Network (ACRIN) 6660 Trial protocol, WBMRI has been compared to more conventional imaging modalities such as positron emission tomography (PET)‐CT.…”

“…As demonstrated above, there is a paucity of large patient series' to definitively compare WBMRI with other modalities, especially PET‐CT. What small case series there are suggest that for most indications PET‐CT and WBMRI are comparable, with the exception of neoplasms with predilection for pulmonary metastasis, in which cases CT or PET‐CT are preferable . As such, the decision regarding the best modality for a given pathology involves many other factors, including institutional availability, individual technologist, radiologist, and clinician (such as oncologist, rheumatologist, or infectious disease specialist) preference and expertise, and cost to the patient.…”