Clinical Application of Whole-body MRI

Article information

J Korean Med Assoc. 2008;51(11):1034-1039

Publication date (electronic) : 2008 November 30

doi : https://doi.org/10.5124/jkma.2008.51.11.1034

Chin A Yi, MD , Kyung Soo Lee, MD , Ji Hye Kim, MD

Department of Radiology, Sungkyunkwan University School of Medicine, Korea.

Corresponding Author: Ji Hye Kim, MD, jhkate@skku.edu

Abstract

Whole body magnetic resonance imaging (WB MRI) has become feasible and enables fast scan throughout the body. This technique is based on a real-time gradient-echo imaging and sliding table platform (rolling table concept, which eliminates time-consuming repositioning of patients and surface coils). MRI scanners of the latest generation use high field MRI units of >1.5 Tesla (T), and are reported to have upgraded capabilities in terms of temporal and spatial resolution due to improved signal-to-noise ratios (SNRs) under high magnetic-field strength conditions. The diagnostic accuracy of the whole-body staging strategies of PET/CT and MRI are established. As a start of tumor staging through whole body imaging, PET/CT showed superior performances in T and N staging than WB MRI using 1.5T MR system. But, both imaging procedures showed a similar performance in detecting distant metastases. In a recent report on staging of non-small cell lung cancer (NSCLC), whole body MR imaging proved to be effective as much as PET/CT in T, N, and M staging. In addition, there were organs of strength for each modality in the detection of metastasis. Therefore, whole-body MRI/ PET would be suggested as a future diagnostic procedure of choice for the whole-body imaging with synergistic effects and reduced radiation exposure.

Keywords: MRI; Whole - body MRI; Application

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Figure 1

Concordant detection of metastasis in a 48-year-old woman with adenocarcinoma in the right lung. (A) Max-imum intensity projection PET image shows a hyper-metabolic mass (arrow) in the left temporal lobe of the brain and a focal hot-uptake lesion (double- arrow) in the left iliac bone, representing brain and bone metastases. (B) Enhanced T1-weighted turbo field-echo whole-body MR image shows a rim-enhancing mass (arrow) in the left temporal lobe of the brain and a focal enhancing lesion (double-arrow) in the left iliac bone, representing brain and bone metastases. Note another smaller metastatic nodule (arrowhead) in the left thalamus of the brain, which was not covered in the field-of-view of the PET/CT.

Figure 2

Images of brain metastasis in a 62-year-old man with NSCLC of the lung detected at whole-body MR imaging, but not at PET/CT. (A) Maximum intensity projection PET image shows a primary lung cancer (arrow) in the left upper lobe, but not metastatic nodule in the brain. (B) Enhanced T1-weighted turbo field -echo whole-body MR image shows a spiculated enhancing primary lung cancer in the left upper lobe (arrow) and a rim-enhancing metastatic nodule (arrowhead) in right cerebella hemisphere in the brain. (C) T2-weighted turbo spin-echo whole-body MR image shows a focal high signal intensity lesion (arrowhead) in the corresponding area of the right cerebella hemisphere. Note primary mass in left upper lobe (arrow). Increase in size on follow-up MR images confirms a brain metastasis.

Table 1

Summary of image acquisition protocols for the whole-body MRI

EPI: echo-planar MR images, FOV: field-of -view, STIR: short- tau inversion recovery, FISP: fast imaging with steady-state precession, RARE: rapid acquisition with relaxation enhancement, NSCLC: non-small cell lung cancer, TIBB: triple-inversion black blood, TSE: turbo-spin echo