Role of Whole Body Diffusion-Weighted MRI in Detection of Skeletal Metastasis

Hesham Salah Mohammed Rashad


Cancer is a potentially life-threatening disease due to its ability to spread to other tissues and organs. Being the most common malignant bone tumor, affecting at least two thirds of the cancer patients, skeletal metastases have a drastic impact on the staging, treatment and quality of life of cancer patients. Bone scan has long been the standard instrument for detecting skeletal metastases, especially osteoblastic metastases, such as breast cancer and prostate cancer. However, the recently developed whole-body magnetic resonance imaging (WB-MRI) has proven better than bone scan in detecting tumors and characterizing skeletal metastases because MR imaging can detect metastatic lesions at an early stage, before the changes in bone metabolism that make lesions detectable on bone scan. Whole body imaging is a vital prerequisite for the management of patients with malignancies. Although bone scans and PET scans are routinely used in the follow up of oncology patients to evaluate metastases, their limited availability and inherent radiation exposure indicate that there is a strong need for a non-invasive, radiation free, whole body imaging modality. Also, the oncology patients are already weakened, not only by the disease entity itself, but also by chemotherapy, there is a possibility that the exorbitant diagnostic radiation which is involved in the bone scans or the PET-CT scans may turn out to be the proverbial last straw on the camel’s back. DWI is a valuable functional imaging technique that can readily be applied to MRI of the whole body. Similar to all other combined anatomic and functional imaging techniques, DWI and conventional sequences demonstrate that the sum is greater than the individual parts, with DWI aiding in both metastatic lesion detection and characterization. Diffusion weighted, whole body magnetic resonance imaging with a background body signal suppression (DWIBS) MRI technique fulfills this much awaited need. DWIBS satisfactorily shows the presence and the extent of the bone as well as the soft tissue metastases. WB-DWI excels at bone marrow assessments at metastasis diagnosis and for therapy response evaluations where it can potentially address unmet clinical and pharmaceutical needs for a reliable measure of tumour response. Signal intensity on high b-value images and ADC value changes can be related to underlying biophysical properties of skeletal metastases and therapy-induced effects. Therapy response criteria need to be established so that they can be then be tested in prospective clinical studies that incorporate conventional measures of patient benefit. Whole-body MR imaging is especially advantageous for use in children because it does not involve exposure to ionizing

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Other Titles دور التصوير بالرنين المغناطيسى باستخدام المتسلسة الانتشارية لكامل الجسم فى اكتشاف انتشار الاورام الى الهيكل العظمى
Issue Date 2014

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