The Whole-Body MRI Reporting and Data System Guidelines for Prostate Cancer (MET-RADS-P), Multiple Myeloma (MY-RADS), and Cancer Screening (ONCO-RADS)

Abstract

Whole-body magnetic resonance imaging (WB-MRI) is being employed with increasing frequency to evaluate a broader spectrum of patients with diverse types of cancer and for cancer screening purposes. While clinical guidelines support its use, a standardized radiological approach is still lacking. To improve consistency in the acquisition, interpretation, and reporting of WB-MRI examinations, three reporting and data systems (RADSs) have been recently suggested: METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P), Myeloma Response Assessment and Diagnosis System (MY-RADS), and Oncologically Relevant Findings Reporting and Data System (ONCO-RADS). MET-RADS-P was developed to stage and monitor men with advanced prostate cancer using WB-MRI. It has emerged as a reliable imaging biomarker for predicting metastatic disease progression and assessing treatment response. MY-RADS was developed to stage and monitor patients with multiple myeloma using WB-MRI, emerging as a prognostic imaging biomarker. However, the evidence regarding inter-reader agreement for MY-RADS is currently limited. ONCO-RADS was developed to standardize the use of WB-MRI for cancer screening in individuals with cancer predisposition syndromes and in the general population. While initial findings are promising, the evidence supporting its use remains limited. To further validate and expand upon these promising preliminary findings, additional large-scale, prospective, multicenter studies are necessary.

Keywords: MET-RADS-P; MRI scans; MY-RADS; ONCO-RADS; RADS; clinical oncology; narrative review; practice guidelines; radiology; whole-body magnetic resonance imaging.

Figure 1

Whole-body magnetic resonance images of a 67-year-old man with metastatic hormone-sensitive prostate cancer showing response to treatment, with primary/dominant Response Assessment Category (RAC) of 1. (a) Axial apparent diffusion coefficient (ADC) map (upper) and T1-weighted (lower) images at the start of luteinizing hormone releasing hormone agonist therapy show the presence of a dorsal spine lesion (arrows) with ADC value of 784 μm²/s. (b) Axial ADC map (upper) and T1-weighted (lower) images at the follow-up show an increase in the spine lesion size accompanied by an increase in the ADC value (1608 μm²/s), suggestive for edema. Thus, this picture was classified as indicative of a highly likely response. Three-dimensional b900 maximum intensity projection images (c) at start of therapy and (d) at follow-up confirm the disappearance of the spine lesion. Reprinted adapting the caption from Pricolo et al. [29] under the terms and conditions of the Creative Commons Attribution 4.0 International License.

Figure 2

Positron emission tomography-computed tomography (PET-CT) and whole-body diffusion-weighted imaging (WB-DWI) of a 55-year-old male with IgA kappa multiple myeloma. (a) Axial images of baseline PET-CT (left panel) show multiple focal lesions with high uptake including one lesion involving T9 and two lesions involving the ilium (white arrows). Axial images of baseline WB-DWI (right panel) show lesions with restricted diffusion (b = 800 s/mm²) also involving T9 and the ilium with an apparent diffusion coefficient ADC of 920 μm²/s (black arrows). (b) Positive post-autologous stem cell transplantation (ASCT) PET-CT (left panel) shows a persistent uptake of T9 (maximum standardized uptake value > liver uptake) and the regression of uptakes within lesions involving the ilium. Positive post-ASCT WB-DWI (right panel) shows a regression of the restricted diffusion in T9 but the persistence of two lesions in the ilium with restricted diffusion and ≤25% increase in the ADC values (ADC = 1000 μm²/s). The subject was in complete remission after ASCT but relapsed 16 months after ASCT. Reprinted adapting the caption from Mesguich et al. [45] under the terms and conditions of the Creative Commons Attribution 4.0 International License.

Figure 3

Imaging findings with Oncologically Relevant Findings Reporting and Data System category 4 in the chest region of two different patients. Sagittal T2-weighted half-Fourier single-shot turbo spin echo (HASTE) (A) and coronal contrast-enhanced T1-weighted gradient echo (GRE) (B) images reveal 17 mm subpleural nodule (arrows) in upper lobe of the left lung in a 62-year-old man. The lesion is seen on the corresponding coronal computed tomography (CT) scan lung window (C) and was confirmed as lung adenocarcinoma after surgical resection. In a 69-year-old woman, a 5.8 cm anterior mediastinal mass with hyperintensity was noted on the T2-weighted HASTE image (D) and contrast enhancement on the T1-weighted GRE image (E). The corresponding axial CT scan (F) demonstrates calcification in mass and thymoma was diagnosed after surgical resection. Reprinted adapting the caption from Hu et al. [52] under the terms and conditions of the Creative Commons Attribution 4.0 International License.