Whole Body MRI in Oncology: Neuroblastoma and Lymphoma. Whole Body MRI in Oncology. WB-MRI Techniques. Without a Moving Tabletop

Size: px

Start display at page:

Download "Whole Body MRI in Oncology: Neuroblastoma and Lymphoma. Whole Body MRI in Oncology. WB-MRI Techniques. Without a Moving Tabletop"

Gerard Sherman
7 years ago
Views:

1 Whole Body MRI in Oncology: Neuroblastoma and Lymphoma Marilyn J. Siegel, M.D. Mallinckrodt Institute of Radiology Washington University Medical Center St. Louis, MO Whole Body MRI in Oncology Describe technical factors in performing whole body MR Demonstrate imaging findings in lymphoma and neuroblastoma Discuss performance characteristics in detection and staging Detection Staging WB-MRI Techniques Two basic options: Without a moving tabletop With a moving tabletop In both cases, table moves 3 to 6 times Differences Patient positioning Total imaging time Image reconstruction Without a Moving Tabletop Images of head, neck, chest & pelvis obtained with patient head-first position Images of legs acquired with patient feet-first Total imaging time ~ minutes Images realigned manually to create whole body image Without a Moving Tabletop Advantages: Moving Tabletop Do not need to change patient position Entire exam done with patient in head-first position Total imaging time ~ 4 to 14 minutes Slices match exactly at each station Images realigned with software Post-processing time reduced 4-yo neuroblastoma 1

2 WB-MRI Technical Factors T2/STIR coronal images 4mm DWI-axial or coronal 4mm b 50, b s/mm2 Head to upper thigh Free breathing Reconstruct 3D MPR and MIP View STIR as gray scale image View DWMRI as inverse gray scale Visual Assessment STIR acquired in coronal plane DW MRI acquired axial or coronal plane What About Gadolinium? Used if lesion is identified on T1- or fat suppressed images Increases lesion conspicuity Remember that normal marrow does not enhance Pathologic lesions enhance Kellenberger. RadioGraphics 2004;24:1317 Padhani A R Radiology 2011;261: Gadolinium in Marrow Objectives T1 T1-FS Gd Tumor enhances Red marrow does not Describe technical factors in performing whole body MR Demonstrate imaging findings Discuss performance characteristics in detection and staging Detection Staging 2

3 Examples of Pathology Tumor Replacement STIR IMAGING STIR Images: Skeleton Tumor in skeleton is bright STIR Images: Extraskeletal Extraskeletal tumor may be intermediate or bright signal intensity Stage 4S neuroblastoma- STIR DIFFUSION WEIGHTED IMAGING Goo Eur J Radiol 2010; 75:

4 Signal low b values Guidelines for Interpreting DW MIR Signal high b values Interpretation High High high-cellularity tumor (restricted flow) High Low Necrosis; fluid (unrestricted flow) b 50 b 800 b 50 b 800 Pitfall--Normal Restricted Tissues can show High Signal Brain Spinal cord Nodes and spleen Salivary glands Bowel Red bone marrow Neuroblastoma DWI b value = 800 Small lymphocytic lymphoma DWI scans with b value 1000 MIP Gray scale MIP Gray scale inverted Goo Eur J Radiol 2010; 75: MIP image gray-scale MIP gray-scale inverted Chavhan G B, Babyn P S Radiographics 2011;31: Lymphoma DW MRI Axial imaging with MIP reconstructions Comparison coronal images T1-W, STIR and greyscale inverted DWI Takahara et al. Radiat Med 2004; 22:275 Kwee Pediatr Radiol ;1592 4

5 Objectives Describe technical factors in performing whole body MR Demonstrate imaging findings Discuss performance characteristics in detection and staging WBMRI in Lymphoma How accurate is it Detection Staging Lymphoma DWI Detection and Staging Lin C et al. Eur Radiol 2010 Von Ufford AJR 2011; 196: Evaluated whole body DW-MR in adults for lesion detection and / or staging FDG/PET as reference standard Visual assessment only of ADC map Results Sens/spec for nodal detection 90%/94% Limited data on extranodal detection Staging: sensitivity 77% to 93% Understaging in 0%; over-staging in 5-23% Lin C et al. Eur Radiol 2010 Von Ufford AJR 2011; 196: Lymphoma ADC image versus PET/CT Whole-body MRI in pediatric lymphoma Limited data In one series using STIR, sensitivity 100% MRI found more lesions in 50% of cases Kellenberger. RadioGraphics 2004;24:131724:1317 Stage IV Hodgkin disease 5

6 Experience in Predicting Treatment Response Personal Experience: Lymphoma before and post-cycle 2 of R-CHOP Early increase in ADC after commencing treatment associated with better outcome Tumors with low baseline pretreatment ADC values respond dbetter to therapy than do tumors with high pretreatment ADC values DWI Pre chemo ADC 0.71 DWI Post chemo ADC 1.19 Detection Staging Treatment response Wu NMR Biomed 2011 Politi Radiology 2010;256 : PET SUV 18.8 PET SUV 5.0 Conclusions: Role of Whole Body MRI in Lymphoma Lesion detection Sensitive for nodal and extranodal tumor Staging Over-stages Response assessment ADC changes correlate with outcome Prospective study with larger cohort is required Neuroblastoma What do we know? Whole body MRI in pediatric tumors Limited data on neuroblastoma alone Data on imaging a variety of small cell tumor Detection of bone metastases sensitivity > 97%, specificity it 99% PPV > 95%, NPV 99% Detection of extraskeletal disease poorer sensitivity 60% Whole-Body MRI in the Staging of Pediatric Malignancies: Results of the American College of Radiology Imaging Network 6660 Trial 188 children with newly diagnosed lymphoma, neuroblastoma, and soft tissue sarcoma All patients underwent WBMRI and conventional imaging, including CT, MRI, scintigraphy and PET/CT Goo Pediatr Radiol 2005; 35: Kumar Pediatr Radiol 2008;38: M J Siegel et al. Radiology

7 Whole-Body MRI in the Staging of Pediatric Malignancies: Results of the American College of Radiology Imaging Network 6660 Trial Neuroblastoma WBMRI detects more skeletal lesions than conventional imaging (p=0.03), but is less sensitive in detecting extraskeletal metastases FN rates for diagnoses of lung and liver were 68.8% and 16.7% in lymphoma compared to 36.7% and 33.3% for solid tumors Cannot replace standard imaging for staging Conclusion: Whole-Body MRI in Pediatric Tumors High resolution No radiation exposure May be reliable for detection of skeletal disease and nodal disease Value in detection of extra-nodal soft tissue and organs lesions will require larger trials Detection Staging Treatment response 7

Case Report: Whole-body Oncologic Imaging with syngo TimCT

Case Report: Whole-body Oncologic Imaging with syngo TimCT Eric Hatfield, M.D. 1 ; Agus Priatna, Ph.D. 2 ; John Kotyk, Ph.D. 1 ; Benjamin Tan, M.D. 1 ; Alto Stemmer 3 ; Stephan Kannengiesser, Ph.D. 3 ;