CTC study shows MRI as potential way forward for lung cancer scans
16 October 2019
A CTC-coordinated lung cancer study published in The Lancet Respiratory Medicine has shown the benefits of using MRI scans in managing a patient’s lung cancer diagnosis.

The Streamline L study reports that for patients with non-small cell lung cancer (NSCLC), a first line whole-body MRI (WB-MRI) scan works just as well as multiple scans in assessing cancer spread and leads to the same treatment decisions - but is quicker, cheaper, preferred by patients and involves less exposure to radiation.

Once a patient has been diagnosed with cancer, doctors usually use a combination of scans such as CT, PET, and MRI to assess how the cancer has spread, as different scans are more effective for different parts of the body. But using multiple scans can take several weeks, exposes patients to higher amounts of ionising radiation, delays the start of treatment and often adds to patient anxiety.

Streamline L, the biggest study of its kind to compare WB-MRI with standard scans in lung cancer, was performed at 16 NHS hospitals and recruited 187 patients. The trial used an innovative design to record the number of scans patients underwent, and captured in real time their influence on treatment decisions made by doctors. It found no significant difference in the accuracy of WB-MRI compared with standard scans in assessing cancer spread or in the treatment recommended as a result, but using WB-MRI scan removed the need for additional scans for nearly all patients, and reduced the average time taken to assess patients by almost a week.

In a small number of cases (less than 20%), WB-MRI generated additional scans, but using an initial WB-MRI, patients were fully assessed within an average of 13 days. This compared to 19 days using the multiple scans in standard staging pathways. The average NHS tariff cost of a WB-MRI staging pathway was £317 – half the £620 cost for the standard staging pathway.

When asked, most patients said they would prefer assessment via WB-MRI.

The UCL Centre for Medical Imaging’s Professor Stuart Taylor, chief investigator for the study, explained the benefits: ‘Use of whole-body MRI could streamline the assessment of cancer patients and become normal practice.

‘In nearly all cases, additional scans were not necessary, and the time saved could lead to treatment starting sooner.' 

He added: ‘Use of whole-body MRI can reduce the number of hospital appointments a patient has to attend, could expose patients to less radiation, and could reduce patient anxiety at what is already an incredibly stressful time’.

Dr Neal Navani, lead clinician for lung cancer at UCLH and one of the study co-authors, said: ‘The earlier we start treating patients, the better their chance of survival. Using whole-body MRI to assess patients may be faster than using usual tests and therefore could save lives’.

There are challenges to rolling out WB-MRI across the NHS, because of limits on the number of available scanners, which are already in high demand, and on the number of radiologists trained to interpret WB-MRI.

Prof Taylor concluded: 'Our trial results show that the NHS should be investing in MRI scanners and training radiologists on interpreting WB-MRI, so that we can reap the benefits of using whole-body MRI in the NHS'.

The publication can be read here.
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