Sunday, June 16, 2019

Whole body MRI scans for preventive screening

With the advances in MRI speed, it is very tempting to get a full body scan to detect stuff that may not be yet symptomatic. In my view, go for it (I plan to discuss it with my doctor**). It is not a bullet proof approach (with misses and false positives) but overall reading the 3 papers below, looks like worth the investment.

I am talking about MRI without contrast. No whole body CT scans as I really believe that no one should do those due to the high radiation levels. Don't want to get a cancer where there was none. I posted on this long ago and most of the experts/doctors will advice against them.

For MRI, except for the contrast, it is completely safe. Notice that traditionally there are real concerns with contrast (serious allergic reactions...) hence should not be used for screening. On top of those, there are new concerns. So let's investigate the other aspects, specially effectiveness without contrast:
  • A paper on the topic of screening asymptomatic patients. Patients paid for the screening. They caught a small percent. So, somebody could argue it wasn't cost effective (see PS) but tell that to the two guys with malignant lesions. [Whole-Body MRI Screening in Asymptomatic Subjects - Preliminary experience and long term follow up findings]
  • Similar paper with 229 patients and similar conclusions. It does explain also limitations, mostly due to the lack of contrast agent and the limitations set on scan time [An initial experience with the use of whole body MRI for cancer screening and regular health checks]
  • Finally one specific to cancer detection. Goes through the different types of cancer and the MRI limitations so it is not a bullet proof approach, but still says it is a good thing, although on the context of diagnoses more than screening.
** Looks like worth getting (again without contrast), but doctor steered me away from it (even when I said I would pay). In my case we are looking to diagnose something quite specific under my rib cage so, suggested an ultrasound. So, waiting for those results but I think that I will probably still do the WB MRI.

On that sense, as usually insurance (public or private) won't pay for it, where to get it? Basically do a search on your browser. Some places nearby my location that pop up (pure examples, no recommendation):
  1. Human Longevity
  2. Desert Medical Imaging
  3. UTSW on full skeleton scan in 7 minutes
Research/startups:
  1. Erzaon  the news
  2. Amra Medical: Focus on body composition
Other whole body scans:
  1. ViaScan: does not talk about MRI (!). It seems to talk about EBT which I didn't realize was around and if it is what I think, it is a CT scan without movable parts (the x-ray beam is produced by an electron beam raster). Claims to be 90% of a CT scan but I don't know how that would be (the detector efficiencies, etc... are the same). That is different from photon counting CT that eventually will be out and does have the promise to reduce dose, but at the time of writing this there are only couple of systems out there.
PS.: Wilson's criteria and WHO criteria for screening. Some may make sense, like why to screen for something if it doesn't have a cure, or if the test in question is really not a good test (lots of false positives or misses). But others are purely economical (!).

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