Abstract
Acknowledging the increasing number of studies describing the use of whole-body MRI for cancer screening, and the increasing number of examinations being performed in patients with known cancers, an international multidisciplinary expert panel of radiologists and a geneticist with subject-specific expertise formulated technical acquisition standards, interpretation criteria, and limitations of whole-body MRI for cancer screening in individuals at higher risk, including those with cancer predisposition syndromes. The Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) proposes a standard protocol for individuals at higher risk, including those with cancer predisposition syndromes. ONCO-RADS emphasizes structured reporting and five assessment categories for the classification of whole-body MRI findings. The ONCO-RADS guidelines are designed to promote standardization and limit variations in the acquisition, interpretation, and reporting of whole-body MRI scans for cancer screening. Published under a CC BY 4.0 license Online supplemental material is available for this article.
Highlights
A meta-analysis by Ballinger et al published in 2017 [10], which described the use of whole-body MRI for baseline cancer screening in 13 study cohorts including patients with Li-Fraumeni syndrome (LFS) from different age groups, showed that most studies included T1-weighted, T2weighted, or diffusion-weighted (DW) sequences
The presence or the absence of any lesions suspicious for cancer The individuals are considered at low risk of cancer; no specific follow-up is required The individuals are considered at intermediate risk of cancer; in higherrisk individuals, whole-body MRI should be repeated at the appropriate time, according to guidelines; in individuals in the general population, clarification of findings including other specific imaging tests is required The individuals are considered at high risk of cancer; further investigations with or without histologic examination are recommended
When higher-risk individuals are diagnosed with findings of ONCO-RADS categories 1–2 or when members of the general population are diagnosed with findings of ONCO-RADS category 3, they are considered to have intermediate likelihood of cancer and active follow-up is planned, as follows: In higher-risk individuals, whole-body MRI should be repeated at the appropriate time, according to guidelines, whereas in members of the general population, appropriate clarification of findings including other specific imaging tests is required
Summary
This Oncologically Relevant Findings Reporting and Data System, or ONCO-RADS, consensus on whole-body MRI for cancer screening proposes standard protocols for higher-risk individuals. The specific aims of the ONCO-RADS recommendations are to (a) establish minimum acceptable technical parameters for whole-body MRI data acquisition for cancer screening in high-risk patients and asymptomatic individuals in the general population; (b) develop standardized data collection methods that enable detailed descriptions of the abnormal findings across multiple anatomic regions; (c) assign the likelihood of malignancy of abnormal findings by using a five-category assessment score to direct further management; (d) enable data collection for outcome evaluations in the context of clinical trials; (e) provide training and educational materials for radiologists on whole-body MRI reporting for cancer screening to limit the variability of imaging interpretations; (f) enhance communication with and between radiologists and with referring clinicians; and (g) promote quality assurance and research in whole-body MRI for cancer screening. Clinical Reporting Template Indication Statement regarding the individual’s risk state
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