Over 10,000 cancer patients have so far had whole-body MRI scans at Paul Strickland Scanner Centre, more than at any other centre in the world. Prof Anwar Padhani, our Lead Consultant for MRI and one of the first doctors in the UK to use whole-body MRI to monitor cancer, explains the benefit of this increasingly valuable scanning technique and what the future might hold.

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Pierre du Bois
25 June, 2021

Over 10,000 cancer patients have so far had whole-body MRI scans at Paul Strickland Scanner Centre, more than at any other centre in the world. Prof Anwar Padhani, our Lead Consultant for MRI and one of the first doctors in the UK to use whole-body MRI to monitor cancer, explains the benefit of this increasingly valuable scanning technique and what the future might hold.

When Prof Padhani was first introduced to the concept of whole-body MRI scanning for cancer in 2012, it was being touted as a way of looking at lymphoma, a cancer of the body’s lymphatic system. However, it was not long before he understood the potential of the technology for other conditions too.

He said: “I quickly realised that the greatest application was going to be in bone disease – most importantly in breast cancer, prostate cancer and multiple myeloma. Thousands of patients with breast and prostate cancer in the UK develop bone-only metastases, which is extremely difficult to evaluate using current technologies.

“These people need to be assessed regularly during their treatment. Traditionally, this has been done using bone and CT scans, however these can be unreliable and confusing when monitoring how patients are responding to treatment over time.

“We know, for example, that 70% of patients with advanced prostate cancer have bone-only disease. We know that 55% of women with breast cancer have bone only disease and we know that 100% of patients with multiple myeloma will have bone disease.

“When we look at the number of deaths per year in myeloma as well as prostate and breast cancer, we can see the magnitude of the problem of therapy monitoring.”

Right mix of expertise and equipment

To be delivered effectively, whole-body MRI requires the right mix of expertise and equipment – both of which can be found at Paul Strickland Scanner Centre.

Prof Padhani said: “Firstly, we have scanners that are able to perform the complex scanning techniques, and given our links with manufacturers of cutting-edge equipment, and our expertise in this area, we are often early adopters of new technology. Secondly, our staff routinely perform between 6 and 9 whole-body MRI scans per day, and after seeing many thousands of whole-body MRI patients, we have the capability within the centre to cope with the workload. Thirdly, we have close links with oncologists who understand the value of whole-body MRI for cancer.”

Prof Padhani predicts that whole-body MRI will be more widely adopted in the UK, although it is currently still experiencing the resistance faced by any new technology for a variety of reasons, not least the way many current treatments are still tied to some of the more traditional scanning techniques like bone and CT scans. In many cases, clinicians will not necessarily know what to do with the new information they get: “For example, an MRI scan might show earlier on that a patient’s disease has progressed than a bone or CT scan would, but the doctor might not have the evidence that intervening at an earlier stage would lead to a better long-term outcome for the patient.”

“Whenever you discover a new technology, you have to go through a number of steps until it is widely adopted in care, ranging from establishing efficacy to society deciding it is prepared to pay for the treatment or technology. In multiple myeloma, whole-body MRI is already accepted in the NICE guidelines, but in prostate cancer for example it is just only entering consciousness and may never get there because of competing techniques such as PET scans.”

 

Picture: Whereas the whole-body bone scan (grey) on the right reported only 3 suspicious areas, the whole-body MRI scan (left) revealed extensive cancer throughout the body of this metastatic breast cancer patient. Red shows the areas of cancer, including in the left breast.


Preventative health screening for rarer cancers

The use of whole-body MRI to carry out preventative screening for people with genetic predispositions to certain types of cancer is now an accepted premise: “The evidence is very good and it’s definitely worth doing.”

Nevertheless, whole-body MRI is currently only available on the NHS for patients who have a higher risk of developing certain types of rare cancers.
“With Li-Fraumeni syndrome, for example, the lifetime risk of developing a cancer is more than 70% for men and more than 90% for women. For those patients, whole-body MRI screening is available on the NHS and is hugely beneficial.

“Health policy makers go for the big killers like breast and prostate cancer, but they don’t go for the smaller killers, as finding them will not have the same impact from a health economics viewpoint. “Additionally, healthcare resources are limited and are therefore targeted at those who are at highest risk of developing disease.

“Preventative health screening is something we will see more of in the future.”


Helping to increase the use of whole-body MRI

According to Prof Padhani, there’s no doubt that the interest in whole-body MRI is rising in the UK, in particular from clinicians working in breast and prostate cancer. In order to increase the use of whole-body MRI in clinical practice, he organises training courses for radiologists as part of his work with the International Cancer Imaging Society. He said: “In January, we remotely trained 40 radiologists in how to read and report whole-body MRI scans.

“We’ve also announced two more training dates for July and half the places are already taken. We’re getting interest from radiologists across the world, including South America.”

He compares the current situation to the way PET scans were first invented in the mid-70s but took a long time until they were widely adopted.”

Artificial intelligence

Prof Padhani also predicts that artificial intelligence (AI) will speed up the diagnostic process, which could give more patients access to
whole-body MRI.

“At the moment, a whole-body MRI scan takes about 45 minutes, but with the help of AI, you may be able to cut that in half. The next thing that will happen is that AI will start to analyse the scan, highlighting abnormalities and changes that have occurred since last time.”

As it has taken six to seven years for AI prototypes to become available for analysing prostate cancer scans, Prof Padhani predicts it will take much longer to develop similar technology for whole-body MRI scanning: “You’re going from scanning one small organ for one disease to scanning the whole body for multiple diseases. The magnitude of the problem is completely different.”

Whatever the future might hold, we can be confident that Prof Padhani will ensure Paul Strickland Scanner Centre remains a leader in whole-body MRI for cancer.

This article was inspired by the paper What's New for Clinical Whole-body MRI (WB-MRI) in the 21st Century, co-authored by Prof Padhani and recently published in the British Journal of Radiology. For more details about the paper, see shorturl.at/fwAW3

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