The Many Uses of Multiparametric MRI

The Many Uses of Multiparametric MRI

THE MANY USES OF MULTIPARAMETRIC MRI

Multiparametric MRI is the combination of multiple types of data acquired during a single MRI session. Evidence is accumulating that this approach offers enhanced clinical value over conventional MRI in an increasing number of disease modalities.1

What is multiparametric MRI?

The multiparametric magnetic resonance imaging (MRI) approach has emerged relatively recently, integrating MRI data to enhance the accuracy of tumor identification and prediction of response to therapy.1 Multiparametric MRI is based on the hypothesis that by combining potentially complementary information on tumor properties available from multiple imaging measures will improve detection, monitoring and prediction of outcomes.1 The data sources for multiparametric MRI are essentially provided by quantitative MRI techniques.1 Multiparametric MRI enables MRI data to be used, for example, to develop predictive mechanistic models of tumor growth and to relate tumor phenotypes to genomic signatures.1

Use in prostate cancer

Multiparametric MRI is now well established in the diagnosis of prostate cancer.2 For example, combing T2-weighted MR imaging, dynamic contrast-enhanced (DCE) MRI, and magnetic resonance spectroscopy (MRS) has been shown to increase the relative probability of tumor detection in the peripheral zone from approximately 0.38 (DCE-MR imaging alone) to 0.78 (combining all measures).3 Multiparametric MRI in prostate cancer has the potential to mitigate the problems in prostate cancer diagnosis, namely overdiagnosis and overtreatment at the same time as underdiagnosis in many men. However, a number of challenges remain that hamper the more widespread implementation of this technology. These include ensuring consistent high-quality execution and reporting of multiparametric MRI.4 Although research in multiparametric MRI in prostate cancer has been ongoing for at least a decade, it is still not routinely used in the diagnostic pathway for prostate cancer. However, it is featured in urological guidelines as having a potential role in specific areas in the management of prostate cancer.5

Use in breast cancer

Multiparametric MRI has also been used in breast cancer to predict the response of breast tumors to neoadjuvant chemotherapy.1 Multiparametric breast MRI with both gadolinium-dependent, DCE-MRI and gadolinium-free techniques have been shown to provide extremely high sensitivity and specificity for detection of breast cancer.6 Multiparametric MRI of the breast can be done at different field strengths (1.5–7 T) and can include established techniques like diffusion-weighted imaging and MRS, as well more recent MRI techniques such as sodium imaging, chemical exchange saturation transfer imaging and hybrid imaging with positron emission tomography (PET).7

Use in other potential applications

Multiparametric MRI, including adding diffusion and perfusion to the routine MRI protocol for rectal cancer has shown considerable promise in the pretreatment staging and post-treatment evaluation. However, the accuracy of the MRI still needs to be improved, particularly for the post-treatment evaluation.8 Other areas where multiparametric MRI has shown promise include: for the diagnosis of non-alcoholic fatty liver disease;9 in the T-staging of bladder cancer, to distinguish non-muscle-invasive from muscle-invasive cancer;10 and for neurodegenerative diseases; to name but a few areas of active research.11 

Where do we stand now?

Given the number of publications on multiparametric MRI approaches in recent years, this approach is clearly being actively researched and is looking increasingly promising.2 However, consensus on optimal practice in image acquisition, data processing, and interpretation has yet to be reached. And as is the case with any emerging healthcare technology, before they become routine in clinical practice, multiparametric MRI protocols will need to have been validated in robust clinical trials for each disease modality.1,2

 

References

  1. Abramson RG, Arlinghaus LR, Dula AN, Quarles CC, Stokes AM, Weis JA, Whisenant JG, Chekmenev EY, Zhukov I, Williams JM, Yankeelov TE. MR imaging biomarkers in oncology clinical trials. Magn Reson Imaging Clin N Am 2016;24:11-29.
  2. Belue MJ, Yilmaz EC, Daryanani A, Turkbey B. Current status of biparametric MRI in prostate cancer diagnosis: literature analysis. Life (Basel) 2022;12.
  3. Turkbey B, Pinto PA, Mani H, Bernardo M, Pang Y, McKinney YL, Khurana K, Ravizzini GC, Albert PS, Merino MJ, Choyke PL. Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation. Radiology 2010;255:89-99.
  4. Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol 2020;17:41-61.
  5. Manfredi M, Mele F, Garrou D, Walz J, Fütterer JJ, Russo F, Vassallo L, Villers A, Emberton M, Valerio M. Multiparametric prostate MRI: technical conduct, standardized report and clinical use. Minerva Urol Nefrol 2018;70:9-21.
  6. Scaranelo AM. What's Hot in Breast MRI. Can Assoc Radiol J 2022;73:125-40.
  7. Pinker K, Helbich TH, Morris EA. The potential of multiparametric MRI of the breast. Br J Radiol 2017;90:20160715.
  8. Gürses B, Böge M, Altınmakas E, Balık E. Multiparametric MRI in rectal cancer. Diagn Interv Radiol 2019;25:175-82.
  9. Schaapman JJ, Tushuizen ME, Coenraad MJ, Lamb HJ. Multiparametric MRI in patients with nonalcoholic fatty liver disease. J Magn Reson Imaging 2021;53:1623-31.
  10. Juri H, Narumi Y, Panebianco V, Osuga K. Staging of bladder cancer with multiparametric MRI. Br J Radiol 2020;93:20200116.
  11. Soni N, Ora M, Bathla G, Nagaraj C, Boles Ponto LL, Graham MM, Saini J, Menda Y. Multiparametric magnetic resonance imaging and positron emission tomography findings in neurodegenerative diseases: Current status and future directions. Neuroradiol J 2021;34:263-88.                                                                                                                                                                                                      S22001474 - JULY 2022