LAUSR

Whole-body magnetic resonance imaging (WBMRI) is increasingly used for the diagnosis, staging, therapy response assessment, and follow-up of patients with several malignancies affecting the bone marrow. Advantages include whole-body coverage, excellent conspicuity for early focal marrow lesions without bone destruction, increased sensitivity for diffuse marrow involvement, and lack of ionizing radiation. WBMRI protocols for bone marrow assessment should include whole-body diffusion-weighted imaging (WBDWI) with coronal maximum intensity projection (MIP) reconstructions and generation of apparent diffusion coefficient (ADC) maps, as well as Dixon-based sequences allowing fat fraction evaluation. Recently, technical consensus guidelines to maximize the accuracy and reproducibility of WBDWI as a quantitative imaging biomarker for oncologic patients were published. Moreover, established guidelines regarding the role of WBMRI in the management of patients with multiple myeloma and advanced prostate cancer are already available. Therefore, this commentary will focus on myeloma and metastatic prostate cancer, although the field of indications for WBMRI of the bone marrow is expanding and the following suggestions on reporting can also be adapted with modifications to WBMRI studies for other disease entities. Detailed structured reporting for WBMRI studies of the bone marrow is mandatory for the systematic collection of data in clinical trials. Ensuring uniformity of reporting is also one of the steps necessary in order to broaden the applicability of WBMRI outside academic expert centers and into daily clinical practice. Furthermore, a well-structured report facilitates interpretation, providing radiologists with a systematic and uniform approach for the evaluation of the very large number of morphological and functional images that are acquired and the correct communication of findings. Such a report should convey to the specialist all imaging information related to the patient’s disease and provide appropriate recommendations, where indicated. Incidental, clinically relevant findings should be described. The report should end with a clear conclusion, enabling at-a-glance assessment of overall disease status. The structured report should include the following components.