The new type of magnetic resonance imaging (MRI) scan could improve care for a type of cancer called myeloma and reduce reliance on bone marrow biopsies, which can be painful for patients and often fail to show doctors how far the disease has spread.
The research is published today (Tuesday) in the journal Radiology and was carried out by researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust.
It received funding from Cancer Research UK and the National Institute for Health Research Clinical Research Facility in Imaging, with additional funding from the EPSRC.
The new whole-body, diffusion-weighted MRI scans showed the spread of cancer throughout the bone marrow of patients with myeloma - one of the most common forms of blood cancer - more accurately than standard tests. The scans also showed whether the patients were responding to cancer treatments.
In the study 26 patients had whole-body, diffusion-weighted MRI scans before and after treatment. In 86% of cases, experienced doctors trained in imaging were able to correctly identify whether patients responded to treatment. The doctors also correctly identified those patients who weren't responding to treatment 80% of the time.
Using the scanning technique, doctors could pinpoint exactly where the cancer was in the bones, with the results available immediately. Conventional tests include bone marrow biopsies and blood tests but neither shows accurately where the cancer is present in the bones.
The researchers also assessed the visible changes on the MRI scans, using a measurement called the Apparent Diffusion Coefficient (ADC), which records how restricted water movement is within tissues. Changes in this measurement correctly identified treatment response for 24 of 25 myeloma patients.
The new scan was able to visualise cancer in almost all bones in the body, with only the skull remaining difficult to image partly because of the frequency of metal dental implants and fillings. The researchers also found the new methods were suitable for more patients than conventional tests; for example, seven patients had bone marrow biopsies but their samples were found to be inadequate for analysis. Performing another biopsy could be traumatic and painful, and may not provide any new information.
Professor Nandita deSouza, Professor of Translational Imaging at The Institute of Cancer Research and Honorary Consultant at The Royal Marsden, said: "This is the first time we've been able to obtain information from all the bones in the entire body for myeloma in one scan without having to rely on individual bone X-rays. It enables us to measure the involvement of individual bones and follow their response to treatment.
"The results can be visualised immediately; we can look on the screen and see straight away where the cancer is and measure how severe it is. The scan is better than blood tests, which don't tell us in which bones the cancer is located. It also reduces the need for uncomfortable biopsies, which don't reveal the extent or severity of the disease."
Dr Faith Davies, member of the Myeloma Targeted Treatment Team at The Institute of Cancer Research and Honorary Consultant at The Royal Marsden, said: "Myeloma can affect bones anywhere in the body, which is why this study is so important. We've shown that whole body MRI scans can accurately monitor how myeloma patients are responding to treatment, allowing doctors to make more informed decisions. With this new scan, if a treatment isn't working the patient can be moved onto new therapies that might be more effective much more quickly.
"This is a small study, so our next step will be to try out the technology in more patients and refine it. In the future we hope this new tool will help doctors extend the life of more myeloma patients. "
Julia Frater, Cancer Research UK's Senior Cancer Information Nurse, said: "Finding kinder ways to monitor how patients respond to treatment is really important, particularly in the case of myeloma where taking bone marrow samples can be painful. This research demonstrates how an advanced imaging technique could provide a whole-skeleton 'snapshot' to track the response of tumours in individual bones. Finding ways to make treatments gentler and improve the experience for patients is an important focus for Cancer Research UK and the research we fund."
Notes to editors
Nearly 4,700 people are diagnosed every year in the UK with myeloma, a disease which affects plasma cells in the blood. These cells grow uncontrollably in bone marrow and become stuck there, disrupting normal blood cell production. Affected bones can be spread throughout the body including the skull, ribs, vertebrae and bones in the arms and legs.
The Apparent Diffusion Coefficient is a quantitative measure of the random thermal movement of water protons within tissues. Water movement is more restricted in tumours because their high cell density restricts the movement of extracellular water.
The Institute of Cancer Research, London, is one of the world's most influential cancer research institutes.
Scientists and clinicians at The Institute of Cancer Research (ICR) are working every day to make a real impact on cancer patients' lives. Through its unique partnership with The Royal Marsden Hospital and 'bench-to-bedside' approach, the ICR is able to create and deliver results in a way that other institutions cannot. Together the two organisations are rated in the top four cancer centres globally.
The ICR has an outstanding record of achievement dating back more than 100 years. It provided the first convincing evidence that DNA damage is the basic cause of cancer, laying the foundation for the now universally accepted idea that cancer is a genetic disease. Today it leads the world at isolating cancer-related genes and discovering new targeted drugs for personalised cancer treatment.
As a college of the University of London, the ICR provides postgraduate higher education of international distinction. It has charitable status and relies on support from partner organisations, charities and the general public.
The ICR's mission is to make the discoveries that defeat cancer. For more information visit http://www.
The Royal Marsden NHS Foundation Trust
The Royal Marsden opened its doors in 1851 as the world's first hospital dedicated to cancer diagnosis, treatment, research and education.
Today, together with its academic partner, The Institute of Cancer Research (ICR), it is the largest and most comprehensive cancer centre in Europe treating over 50,000 NHS and private patients every year. It is a centre of excellence with an international reputation for groundbreaking research and pioneering the very latest in cancer treatments and technologies.
The Royal Marsden, with the ICR, is the only National Institute for Health Research Biomedical Research Centre for Cancer. First awarded the status in 2006, it was re-awarded in 2011. A total of £62 million is being provided over five years, to support pioneering research work, and is being shared out over eight different cancer themes.
The Royal Marsden also provides community services in the London boroughs of Sutton and Merton and in June 2010, along with the ICR, the Trust launched a new academic partnership with Mount Vernon Cancer Centre in Middlesex.
Since 2004, the hospital's charity, The Royal Marsden Cancer Charity, has helped raise over £100 million to build theatres, diagnostic centres, and drug development units.
Prince William became President of The Royal Marsden in 2007, following a long royal connection with the hospital.
About Cancer Research UK
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- The charity's pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.
- Cancer Research UK receives no government funding for its life-saving research. Every step it makes towards beating cancer relies on every pound donated.
- Cancer Research UK has been at the heart of the progress that has already seen survival rates in the UK double in the last forty years.
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