November 30, 2017
Abbreviated MRI protocols could dramatically improve the diagnosis of breast cancer and lead to the earlier diagnosis of a lot more women, especially those with fast-growing cancers, according to an ongoing study.
"Mammograms detect slow-growing cancers but, notoriously, deliver false negatives for rapid-growing cancers," said Christiane Kuhl, MD, from University of Aachen in Germany.
"We have good reason to search for other methods," she pointed out.
Traditionally, MRI has only been used to characterize a cancer, to map known disease. "But we are seeing that it's by far the most accurate imaging method for diagnosis," she told Medscape Medical News.
"Breast MRI has the sensitivity profile we want to see in screening methods used today," Dr Kuhl said.
She and her colleagues are conducting the ongoing large-scale phase 2 EA1141 trial to investigate the utility of abbreviated MRI for screening in 1450 women with dense breast tissue who are at average risk for breast cancer (NCT02933489).
At the Radiological Society of North America (RSNA) 2017 Annual Meeting in Chicago, Dr Kuhl discussed the premise for the EA1141 trial.
Biologically relevant cancers can exhibit features that render them indistinguishable from normal or benign breast tissue on mammography. "But only a small fraction of women qualify for breast MRI," she explained.
A typical MRI study takes up to 40 minutes and generates several hundred images. An abbreviated MRI has a 3-minute magnet time and an abridged image interpretation time (about 30 seconds), generates only one precontrast and one postcontrast T1 weighted image set, and uses maximum-intensity projections to fuse the first postcontrast subtracted images into one single high-contrast image.
"The new era is about finding more, earlier, then using targeted therapies to be more efficient," she said, explaining that her group started publishing studies that showed the advantages of abbreviated MRI in 2014. "Surprisingly, it's still considered new," she said.
In an early study, the diagnostic accuracy of abbreviated breast MRI was shown by Dr Kuhl's team to be equivalent to that of a diagnostic protocol that took 17 minutes (J Clin Oncol. 2014;32:2304-2310). In addition, because women were diagnosed with greater efficiency, the cancer yield increased by 18.2 per 1000 people, as reported by Medscape Medical News.
In a more recent study, the team showed that MRI screening improves the early diagnosis of prognostically relevant breast cancer in women at average risk for breast cancer (Radiology. 2017;283:361-370).
Currently, there are about 16 publications that confirm that abbreviated MRI is the best way to detect breast cancer, Dr Kuhl reported. It is generally agreed, however, that "it's way too expensive."
"If it's just a matter of cost, let's find other ways," she said. Maybe with abbreviated MRI "we will change the way we screen for breast cancer in the foreseeable future."
"It's been difficult for people to think outside the box," she said, adding that MRI does not have to be a long process. "Having dedicated magnets optimized for fast patient throughput will be crucial for taking advantage of this approach."
Benefits of Fast MRI
Fast MRI protocols can also improve the diagnosis of conditions other than breast cancer. Dr Kuhl's group recently showed that abbreviated biparametric MRI improved the detection of clinically significant prostate cancer in men with elevated levels of prostate-specific antigen (Radiology. 2017;285:493-505).
And in a study also presented at the RSNA meeting, a 5-minute MRI protocol was as accurate as standard knee MRI for the evaluation of internal derangement of the knee.
"The two were diagnostically interchangeable, particularly for our patients who have claustrophobia or pain," said Erin Alaia, MD, assistant professor of radiology at NYU Langone Health in New York City.
For their study, Dr Alaia and her colleagues assessed patients who underwent MRI at two academic centers from January 2015 to July 2016. Of the 146 patients, 100 underwent 3T MRI (100 scans) and 46 underwent 1.5T MRI (50 scans).
Four musculoskeletal radiologists evaluated menisci, ligaments, cartilage, and bone, and compared five fast multiplanar 2D FSE sequences using parallel imaging with 5 standard sequences.
"We compared and saw the same results," Dr Alaia reported.
"We just need to get the image quality that's necessary for the diagnosis," said her colleague Naveen Subhas, MD, associate professor of radiology at the Cleveland Clinic. "That's going to take some time for a lot of people to get their heads around."
"From volume-based to value-based imaging, I think this is a paradigm shift that's going to happen," Dr Subhas said.
Dr Khul, Dr Alaia, and Dr Subhas have disclosed no relevant financial relationships.