Study design and patient cohort

Over the course of three months, 13 patients (4 men and 9 women, aged 46-73 years) with various oncological diagnoses participated in the study. Among them were patients with breast cancer, prostate cancer, synonasal carcinoma, lymphoma, and other solid tumors. Each of them had either confirmed advanced disease or strong clinical indicators (e.g., elevated tumor markers, persistent pain) that indicated suspected metastatic spread. Although CT is the main method for primary cancer diagnosis in Ukraine, the shortage of PET-CT equipment and radiopharmaceuticals has forced clinicians to look for other reliable imaging modalities, including MRI-based imaging.

MRI protocol

All participants underwent a WB-DWI examination using 1.5T MRI, the protocol covering areas from the base of the skull to mid-thigh, with extension to the lower extremities if clinically indicated. The main sequences included

Axial DWI/ADC (diffusion-weighted imaging with corresponding apparent diffusion coefficient map)

Axial T2-weighted imaging

Sagittal T1_DIXON

Coronal T2_SPIR

These sequences, selected to balance acquisition time with diagnostic efficiency, allow detection of both soft tissue and bone marrow lesions. DWI is particularly sensitive to changes in tissue cellularity and water mobility, often highlighting malignant lesions as areas of limited diffusion. T1_DIXON and T2_SPIR provide anatomical context, facilitating differentiation between malignant lesions and other possible abnormalities such as benign cysts, hemorrhagic lesions, or degenerative changes.

CT protocol

All patients also underwent contrast-enhanced CT scans of the chest, abdomen, and pelvis (and, if indicated, the head). Typical slice thicknesses ranged from 1 to 5 mm, and reconstructions were performed in several planes. The radiologists evaluated these images for potential metastatic involvement of visceral organs, lungs, and for changes in lymph nodes or bone structure.

PET-CT protocol

In two cases, patients had access to [18F]FDG PET-CT. After an appropriate period of fasting and radionuclide injection, scans were performed to assess metabolic activity in suspicious areas. PET-CT is often considered the gold standard for detecting highly metabolically active lesions, but its availability in Ukraine is severely limited, partly due to cost and partly due to logistical difficulties associated with the production and distribution of radiopharmaceuticals. 

Benefits of MRI and WB-DWI

Sensitivity to bone marrow infiltration: According to Heindel et al. (2014), MRI can detect metastatic bone marrow changes earlier than conventional CT, as it visualizes changes in bone marrow composition before cortical destruction becomes apparent. This is very useful for cancers that predominantly spread to the bone, such as breast cancer and prostate cancer.

Monitoring the response to treatment: Lecouvet et al. (2013) point out that MRI, in particular DWI, helps monitor response to therapy by detecting changes in the diffusivity of water in tumors. This can be crucial for timely adjustment of treatment regimens.

Comparable or higher efficacy in certain types of cancer: Schraml et al. (2013) found that whole-body MRI can be comparable to [68Ga]Ga-DOTA-TOCPET-CT for staging neuroendocrine tumors, emphasizing its utility in a variety of malignancies.

Technological progress: A recent paper (Lecouvet et al., 2024) highlights the continuous improvement of MRI hardware and software, making WB-MRI faster and easier to implement in routine practice.

Resource constraints in Ukraine

The war with Russia has severely impacted Ukraine's healthcare infrastructure, making it difficult to both finance and procure high-tech medical equipment. PET-CT machines remain in short supply, and the production or import of radiopharmaceuticals faces logistical obstacles. In contrast, many Ukrainian hospitals and medical centers already have operating MRI scanners that can be used for WB-DWI. This accessibility makes it a practical and potentially safer alternative for repeat examinations when PET-CT is not possible.