BY Samuel Mathis, MD, MBA, Assistant Professor, UTMB
Recently, I have had patients request that I order whole-body MRI (WB-MRI) evaluations for preventative services. The trend of WB-MRIs has gained some traction in Europe over the past 5 years and is becoming increasingly popular in the US. A quick internet search found 3 different companies in the greater Houston area that offer these studies with multiple new organizations opening in the next 6-12 months. Let’s explore the evidence surrounding whole body MRIs and compare the benefits vs risks associated with them.
For many health-conscious consumers, WB-MRIs offer the best of both worlds in terms of imaging evaluations for cancers and other growths/findings. MRIs have the benefit of no radiation associated with imaging and are detailed enough to identify abnormal growths or early tumors. Contrary to diagnostic MRIs, WB-MRIs utilized bigger cuts and can be performed in under 1 hour for most patients. These types of MRIs are utilized by oncologists for patients with known disease to help identify any possible metastasis. This combination of speed and diagnostic clarity has created numerous organizations that offer services for anywhere between $600-2,500 dollars. The companies that provide these services offer a radiologist to read the images and a physician consultation of the results.
One of the biggest questions asked about these MRIs are how effective they are at identifying abnormalities. A 2019 European systematic review of over 5,000 subjects showed that WB-MRIs identified critical and incidental findings in 32.1% of all cases (1). These findings have been replicated in repeat studies (2, 3). Of those, it was estimated that 13.4% of all findings were critical in nature (1). A US study in 2020 found that out of over 6,000 WB-MRI examinations, there were 17,961 abnormal findings (2). Of those findings, 9% were relevant and required further evaluation and 0.5% were suspicious for cancer (2). The bulk of positive findings were related to cardiovascular and the colon. The estimated false positive findings were calculated at a pooled proportion of 16% (1). Unfortunately, none of the studies looked at the additional imaging, biopsy, or other workup needed to identify all these positive findings, critical or otherwise).
A repeat review in 2022 out of Germany found similar results with one additional caveat. This study looked at the potential cost associated with WB-MRI for patient care. The study found that 2 years following a WB-MRI, costs for participants were 295 euros $316 more than those who did not have a WB-MRI performed. This correlated to a 11.6% increase in baseline costs associated with the individual’s care (2). In America, the average cost of healthcare is estimated at $13,493 per person. An 11% increase in cost equates to over $1,250 per person. These costs would be untenable in the long term if instituted on a national scale.
How then do we engage with patients who wish to pursue WB-MRIs? First and foremost, these patients should be commended for their dedication to health and wellbeing. Many times, patients have underlying psychological or emotional reasons to request this testing. A few extra minutes to identify the reasons for a patient’s request may help guide the conversation and identify what the patient truly wants. The second way to engage with these requests is to have a frank and open discussion about the benefits and costs associated with this testing. Many patients do not recognize the relatively high likelihood of finding an incidental finding and the associated stress associated with positive findings. Once they understand the low likelihood of positive findings, patients may choose to forego additional testing. Finally, discuss the cost of these procedures with patients. Many of these studies are not covered by insurance and will require significant out of pocket costs since the imaging is not warranted based on the patient’s clinical picture.
Overall, the evidence and significant costs do not yet support a standard recommendation of whole-body MRIs for preventative service evaluations in the general patient population. There may be a role for these studies in the future, but they currently cause significant workups that continue to tax our healthcare system and patient’s pocketbooks.
References
- Kwee RM, Kwee TC. Whole-body MRI for preventive health screening: A systematic review of the literature. J Magn Reson Imaging. 2019 Nov;50(5):1489-1503. doi: 10.1002/jmri.26736. Epub 2019 Apr 1. PMID: 30932247; PMCID: PMC6850647.
- Zugni F, Padhani AR, Koh DM, Summers PE, Bellomi M, Petralia G. Whole-body magnetic resonance imaging (WB-MRI) for cancer screening in asymptomatic subjects of the general population: review and recommendations. Cancer Imaging. 2020 May 11;20(1):34. doi: 10.1186/s40644-020-00315-0. PMID: 32393345; PMCID: PMC7216394.
- Schmidt CO, Sierocinski E, Baumeister S, Hegenscheid K, Völzke H, Chenot JF. Effects of whole-body MRI on outpatient health service costs: a general-population prospective cohort study in Mecklenburg-Vorpommern, Germany. BMJ Open. 2022 Jan 7;12(1):e056572. doi: 10.1136/bmjopen-2021-056572. PMID: 34996801; PMCID: PMC8744128.