Applying ONCO-RADS to whole-body MRI cancer screening in a retrospective cohort of asymptomatic individuals

Abstract

Background: Whole-body magnetic resonance imaging (WB-MRI) has emerged as a valuable tool for cancer detection. This study evaluated the prevalence rates of cancer in asymptomatic individuals undergoing WB-MRI according to the Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) classifications in order to assess the reliability of the classification method.

Methods: We retrospectively enrolled 2064 asymptomatic individuals who participated in a WB-MRI cancer screening program between 2017 and 2022. WB-MRI was acquired on a 3-T system with a standard protocol, including regional multisequence and gadolinium-based contrast agent-enhanced oncologic MRI. Results of further examinations, including additional imaging and histopathology examinations, performed at our institute were used to validate the WB-MRI findings. Two radiologists blinded to the clinical outcome classified the WB-MRI findings according to the ONCO-RADS categories as follows: 1 (normal), 2 (benign finding highly likely), 3 (benign finding likely), 4 (malignant finding likely), and 5 (malignant finding highly likely). Firth logistic regression analysis was performed to determine the associations between participant characteristics and findings of ONCO-RADS category ≥ 4.

Results: Of the 2064 participants with median age of 55 years, 1120 (54.3%) were men, 43 (2.1%) had findings of ONCO-RADS category ≥ 4, and 24 (1.2%) had confirmed cancer. The cancer prevalence rates were 0.1%, 5.4%, 42.9%, and 75% for ONCO-RADS categories 2, 3, 4, and 5, respectively. In the multivariable model, older age (OR: 1.035, p = 0.029) and history of hypertension (OR: 2.051, p = 0.026), hepatitis B carrier (OR: 2.584, p = 0.013), or prior surgery (OR: 3.787, p < 0.001) were independently associated with the findings for ONCO-RADS category ≥ 4.

Conclusions: The ONCO-RADS categories for cancer risk stratification were validated and found to be positively correlated with cancer risk. The application of ONCO-RADS facilitates risk-based management after WB-MRI for cancer screening.

Keywords: ONCO-RADS; Whole-body magnetic resonance imaging; cancer screening.

Fig. 1

Imaging findings with Oncologically Relevant Findings Reporting and Data System category 4 in the head region. Axial T2 fluid-attenuated inversion recovery (A) and coronal T2-weighted (B) images show a hyperintense area in right temporal lobe of 41-year-old woman. Lesion was confirmed to be anaplastic astrocytoma after surgical resection. In 61-year-old man, axial T2-weighted (C) and contrast-enhanced T1-weighted (D) images reveal left tonsil lesion with heterogeneously high signal intensity, which was diagnosed as squamous cell carcinoma after biopsy

Fig. 2

Imaging findings with Oncologically Relevant Findings Reporting and Data System category 4 in neck region. Axial T2-weighted (A) and contrast-enhanced T1-weighted (B) images show solid thyroid nodule (arrows) in right lobe of 63-year-old woman. Corresponding color Doppler ultrasound image (C) reveals 1.3-cm hypoechoic and hypervascular lesion with histopathology diagnosis of papillary carcinoma. In 67-year-old man, solid lesion (arrowheads) with adjacent daughter nodule was detected in right parotid gland, demonstrating hyperintensity on T2-weighted image (D) and contrast enhancement on T1-weighted image (E). Lesion was hypoechoic on ultrasound image (F) and was determined to be Warthin’s tumor by fine-needle aspiration cytology

Fig. 3

Imaging findings with Oncologically Relevant Findings Reporting and Data System category 4 in chest region. Sagittal T2 half-Fourier single-shot turbo spin echo (HASTE) (A) and coronal contrast-enhanced T1 gradient echo (GRE) (B) images reveal 17-mm subpleural nodule (arrows) in upper lobe of left lung in 62-year-old man. Lesion is seen on corresponding coronal CT scan lung window (C) and was confirmed as lung adenocarcinoma after surgical resection. In 69-year-old woman, 5.8-cm anterior mediastinal mass with hyperintensity was noted on T2 HASTE image (D) and contrast enhancement on T1 GRE image (E). Corresponding axial CT scan (F) demonstrates calcification in mass and thymoma was diagnosed after surgical resection

Fig. 4

Imaging findings with Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) category 4 in abdominal region and ONCO-RADS category 5 in pelvic region. In 75-year-old man, 3.6-cm exophytic mass (arrows) from lesser curvature of stomach is depicted on axial T2-weighted image (A) and T1-weighted images before (B) and after (C) contrast enhancement. Diagnosis of stromal cell tumor was given after laparoscopic resection. Axial T2-weighted image (D) revealed focal lesion (arrowheads) in left transition zone with low signal intensity, measuring more than 1.5 cm. Lesion shows marked diffusion restriction on diffusion-weighted imaging (E) and corresponding apparent diffusion coefficient map (F) and was classified as ONCO-RADS category 5. Prostate cancer was confirmed in 58-year-old man after biopsy directed by cognitive MRI-transrectal-ultrasound fusion technique