The added value of advanced multi-modal magnetic resonance imaging in the diagnosis and management of childhood cancer

Background: Magnetic Resonance Imaging (MRI) provides images with excellent structural detail, but imparts limited information about the characteristics of paediatric tumours. MRI based functional imaging probes tissue properties to provide clinically important information about metabolites, structure and cellularity. Aim: To determine the added value of advanced MRI, particularly diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS), in non-invasive diagnosis and management of paediatric tumours, and facilitate integration into clinical practice. Methods: Children with newly diagnosed body and brain tumours were imaged using multi b-value DWI and MRS respectively. Imaging data was used to develop a clinical decision support system for presentation to clinicians. Added diagnostic and clinical value of additional information was ascertained through retrospective and prospective evaluation. Results: Quantitative DWI confers added diagnostic accuracy beyond conventional MRI, allowing discrimination of benign from malignant body tumours through morphological and quantifiably significant differences in Apparent Diffusion Coefficient (ADC) histograms. Chemotherapeutic response is reflected through visually apparent and quantifiably significant histogram changes. Review of MRS improves diagnostic accuracy of paediatric brain tumours, adding therapeutic value through avoiding biopsy of indolent lesions, aiding tumour characterisation, and allowing earlier treatment planning and clinical decision-making. Conclusion: Advanced MRI adds value to non-invasive diagnosis and management of paediatric tumours in a real-time clinical setting. Presentation of complex information through a decision support system makes it accessible and comprehensible for clinicians, overcoming barriers precluding clinical use. Multicentre assessment is needed to promote integration of these techniques into the clinical workflow to improve care of children with cancer