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Contrast Agent Boosts Full-Body MRI For Kids

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A new contrast agent makes MRI a viable—and radiation-free—alternative to PET-CT for whole-body scanning of children, according to an article published online today in The Lancet Oncology.

Senior author Heike Daldrup-Link, MD, an associate professor of radiology at Stanford University, hailed the technique as a breakthrough:

I’m excited about having an imaging test for cancer patients that requires zero radiation exposure. That is a big deal.

Dr. Daldrup-Link was quoted in a Stanford news release.

Research on the new technique focused on children and young adults with lymphoma or sarcoma. Both cancers can spread throughout the body. A whole-body PET-CT scan does a good job of finding tumors, but it exposes children to as much radiation as 700 chest X-rays.

MRI has its own drawbacks. It takes up to two hours—too long for existing contrast agents to stay in target tissues. And it doesn’t do as well in distinguishing tumors from healthy tissue.

Stanford researchers tried a new contrast agent made with iron nanoparticles. The Food and Drug Administration has already approved the particles for anemia treatment, and they stay in the body for several days. They also do a good job of making tumors stand out in bone marrow, lymph nodes, the liver, and the spleen.

The researchers paired the nanoparticles with diffusion-weighted MRI to scan 22 lymphoma or sarcoma patients, ages 8 to 33.

PET-CT scans detected 163 of 174 total tumors. MRI found 158. Sensitivity, specificity, and diagnostic accuracy were similar. No patients experienced adverse reactions to the contrast agent, although the FDA has noted a small risk of allergic reaction to the nanoparticles’ coating.

Dr. Daldrup-Link said she has been sharing the new technique with colleagues around the country. “Some type of whole-body MRI imaging test is available at many big children’s hospitals right now,” she said. “It’s slowly entering clinical practice, but clinicians are cautious and want to be convinced.”

This study may convince them. One big hurdle does remain: There’s not yet a billing code. With the October 1 deadline for ICD-10 implementation barreling down on us, that could be a problem.

Related CME seminar (up to 27 AMA PRA Category 1 credits™): Pediatric Radiology

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