OVERVIEW

  • Whole body (WB-MRI) or whole spine (WS-MRI) imaging allows visualization of the entire body (from the head to the lower extremity) or entire spine, respectively in a single examination.
  • Traditional MRI imaging is limited to localized areas.

COMMON INDICATIONS

  1. Diagnosis
  2. Screening
  3. Surveillance
  4. Virtual autopsy-WM MRI may be an alternative tool especially in fetal and neonatal deaths. It is less invasive and allows for accurate whole body evaluation. However, it still cannot replace traditional autopsy.

 

DIAGNOSTIC USES

  • Oncology- Metastatic disease, multiple myeloma, lymphoma
  • Spondyloarthropathies
  • Multifocal inflammatory muscle diseases- myositis, dermatomyositis
  • Multifocal vascular disease.
  • Multifocal neurological disease, especially those with malignant potential- neurofibromatosis.
  • Multifocal infection- osteomyelitis and invasive infections in infants, especially due to their inability to localize symptoms and signs.

 

SCREENING

Early detection of disease in asymptomatic groups of persons.
For example:

  • Cancer screening in children with genetic cancerpredisposing conditions (Li-Fraumeni syndroma,  rhabdoid tumor syndrome, hereditary paragangliomapheochromocytoma syndrome)
  • Colonic, bronchial or renal carcinoma in general population.
  • Atherosclerosis in combination with cerebral and cardiac MRI.

 

MULTIPLE MYELOMA

  • Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group.
  • WB-MRI is the imaging reference standard for the detection of bone marrow involvement.
  • Systematic WB-MR imaging in patients with smouldering and asymptomatic disease is recommended.
  • Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on MRI are considered having symptomatic myeloma requiring treatment, regardless of the presence of lytic bone lesions.

 

SURVEILLANCE

  • High risk for a particular disease. For example, liver cancer in a patient with viral hepatitis or cirrhosis.
  • Whole spine imaging is also used in the assessment and surveillance of scoliosis.

 

COMPARISON
WHOLE BODY/SPINE vs. NUCLEAR MEDICINE BONE SCAN

  • WB-MRI outperforms nuclear medicine bone scan for detection of metastases in solid cancers.
  • MR in at least equivalent to and is often superior to scintigraphy for bone metastasis detection.
  • MRI provides better anatomic detail and spatial resolution.
  • Nuclear medicine is invasive and exposes the patient to ionizing radiation.

 

ADVANTAGES OF WB and WS IMAGING

  • Non-invasive
  •  Extensive coverage- single examination of the entire body/ spine
  • Excellent contrast and spatial resolution of WB MRI
  • Cost reduction. Complete disease assessment in a single examination, especially in an oncology setting.
  • Radiation free. Important in paediatric oncology and is technique of choice for rapid staging of a malignancy appearing in pregnancy.
  • Does not usually require contrast.

 

WHOLE BODY IMAGING

 

 

 

WHOLE SPINE IMAGING

 

LIMITATIONS

  1. Claustrophobia
  2. Metallic body implants
  3. Relatively long examination time (30 mins to 1 hour)
  4. False positive results: infections, inflammatory pathologies and benign entities such as cysts and vascular abnormalities can simulate malignant processes.

 

 

REFERENCES
• Lecouvet, Frederic. “Whole-Body MR Imaging: Musculoskeletal Applications.” Radiology, pubs.rsna.org/doi/abs/10.1148/radiol.2016142084.
• Tarnoki, David Laszlo, et al. “Clinical Value of Whole-Body Magnetic Resonance Imaging in Health Screening of General Adult Population.” Radiology and Oncology, Versita,
Warsaw, Mar. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4362601/.
• Teixeira, Sara Reis, et al. “Whole-Body Magnetic Resonance Imaging in Children: State of the Art.” Radiologia Brasileira, Colégio Brasileiro De Radiologia e Diagnóstico Por
Imagem, www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-39842015000200011.
• Deutscher Ärzteverlag GmbH, Redaktion Deutsches Ärzteblatt. “The Uses and Limitations of Whole-Body Magnetic Resonance Imaging (04.06.2010).” Deutsches Ärzteblatt,
www.aerzteblatt.de/int/archive/article/76377.
• www.massgeneral.org/imaging/news/radrounds/may_2010