WHAT WE DO



Diffusion Whole Body (DWB) is a diagnostic examination that uses a latest-generation magnetic resonance machinery to identify tumours as small as 3-4 millimeters throughout the body.

The aim of DWB is the early diagnosis of tumours, in a way that they can be treated when they are small and localized, with the best chance to cure them. It is an evolution of the use of an MR scanner already used on the market, that has been “specialized” to identify tumours.


DIFFUSION WHOLE BODY


Eight years of trials at the European Institute of Oncologyin cooperation with other European medical centres, has seen the Diffusion Whole Body (DWB) Examination reconfigured and the scanner performance improved to satisfy clinical needs for non-invasive diagnosis, and to reduce the duration of the examination,from over 50 minutes to roughly 30 minutes now.

Like all MRI scans, DWB doesn’t involve ionizing radiation, and doesn’t require the injection of contrast agents. It is a non-invasive examination with zero-biological risk. The basis of the technique is simple: it reveals movements of water molecules, that when trapped in a hypercellular tissue (typical of tumours) produce a much stronger signal in the images. This allows us to detect cancer lesions as small as 3-4 millimeters; small enough to provide an effective early diagnosis.




The value and characteristics of Diffusion Whole Body explained by Dr. Giuseppe Petralia, Radiologist at ASC Italy and Vice-Director of Radiology at IEO:

EXAMINATION



USEFULNESS OF THE EXAMINATION

Diffusion Whole Body requires the use of a latest-generation magnetic resonance scanner. In a short time it produces thousands of detailed images of organs and tissues for identifying cancer lesions of just a few millimeters; a dimension in which they are still at an early stage and thus treatable in a less invasive ways and with a high margin of success. More advanced than traditional magnetic resonance scans, DWB is the result of years of research and study that allows us to reach an early diagnosis, that in some cases could be a life-saving.


SIMPLICITY OF THE EXAMINATION

A DWB examination is like other, standard radiological investigation, but no specific preparation is needed; one does not take medication, do an enema or fast.




PERFORMING THE EXAMINATION

After the standard administrative work at reception, a radiographer will guide you to a preparation area near MRI scanner, where our specialist radiologist will assess the feasibility and safety of DWB examination for you on the basis of an in-depth interview regarding your medical history and discussion of the DWB examination process. On the doctor’s approval, you will then proceed to the MR scanner.
After you have changed into a hospital gown, the radiographer will help you get into position on the MRI bed and start the examination. While performing the DWB examination, the radiographer remains in continuous audio and visual contact. DWB examination is painless, and you can listen to music while the scans are performed.


END OF THE EXAMINATION

After about 30 minutes, when all the images have been acquired the specialist radiologist will assess the image quality and authorise the end of the examination. You will then leave MRI room, and change back into your regular clothes. After a final discussion with the specialist radiologist you will have completed the examination. Once the examination is finished, you can return to your usual activities with no limitations. All the examinations will be reviewed by one of IEO’s radiologists.


THE IMPORTANCE OF EARLY DIAGNOSIS


A study published in the Annals of Oncology estimates that in 2014, 250 000 cancer deaths will be avoided in Europe thanks to prevention efforts such as breast and colon cancer screening. The reason why is well known: the smaller the cancer, the bigger the chances of recovery and the smaller the collateral effects of therapy.

Writing in L’Espresso in 2014, Prof. Umberto Veronesi identified two routes to early diagnosis: molecular imaging, that allow to detect cancer marker in blood and the evolution of magnetic resonance.

He promoted the research on Diffusion Whole Body at IEO, as the type of magnetic resonance study best suited to detecting cancer at an early stage.


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Cancer diagnoses in 2006



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Cancer diagnoses in 2016



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Estimated cancer diagnoses in 2020


dati da “I numeri del cancro in Italia 2016” a cura di AIOM e AIRTUM


TESTIMONIALS



Fabio Armiliato – Tenor

“we have always believed in prevention, in the integrity of health and in living at the best our existence and our art”.


Simone Moro – Climber

“I’ve always been interested and carefully attentive to the human body’s physiology, not only to keep healthy but also to pay aware of warning signals. I think that this care saved me few times”.

SCIENTIFIC PUBLICATIONS

For an MRI examination, the patient is placed in a large magnet. Then, using radiofrequency magnetic field pulses at the appropriate “resonant” frequency, hydrogen atoms are tipped out of their equilibrium. The MRI scanner detects the signal induced by the hydrogen atoms (mainly from water and fat) during their return to equilibrium.

A computer then transforms this signal to produce anatomical and functional images of the human body. All this takes place without exposing the patient to ionizing radiation. MRI has been used routinely to produce detailed anatomical images of patients for more than 30 years. For about 25 years, it has been possible to use MRI to study the microscopic diffusion of water molecules in the human body (diffusion weighted MRI technique) as a means for obtaining clinically useful information [1]. The first clinical application of diffusion weighted MRI was in the detection of stroke in the brain, but in the last 10 years diffusion weighted MRI has seen growing use in cancer imaging throughout the body [2].

Thanks to technological developments in the last few years, it is now possible to capture images of the whole body with the diffusion weighted MRI technique in a short time, giving rise to the Diffusion Whole Body (DWB) examination [3].

The execution of DWB examinations, and the interpretation of the resulting images have been standardised by the leading research centres [4] and the technique has progressively become available for cancer patients [5]. Recent scientific publications report a diagnostic accuracy of DWB comparable to that of other and older whole body imaging techniques that use radiation and contrast agents, such as Positron Emission Tomography (PET) and Computed Tomography (CT) [6,7].


  1. Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. 1986 Nov;161(2):401-7.
    http://mriquestions.com/uploads/3/4/5/7/34572113/dlbihanradiology1986.pdf
  2. Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T, Dzik-Jurasz A, Ross BD, Van Cauteren M, Collins D, Hammoud DA, Rustin GJ, Taouli B, Choyke PL. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. 2009 Feb;11(2):102-25.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631136/
  3. Kwee TC, Takahara T, Ochiai R, Katahira K, Van Cauteren M, Imai Y, Nievelstein RA, Luijten PR. Whole-body diffusion-weighted magnetic resonance imaging. Eur J Radiol. 2009 Jun;70(3):409-17. doi: 10.1016/j.ejrad.2009.03.054
    https://www.ncbi.nlm.nih.gov/pubmed/19403255
    http://www.ejradiology.com/article/S0720-048X(09)00181-8/fulltext
  4. Koh DM, Blackledge M, Padhani AR, Takahara T, Kwee TC, Leach MO, Collins DJ. Whole-body diffusion-weighted MRI: tips, tricks, and pitfalls. AJR Am J Roentgenol. 2012 Aug;199(2):252-62. doi: 10.2214/AJR.11.7866.
    https://www.ncbi.nlm.nih.gov/pubmed/22826385
    http://www.ajronline.org/doi/abs/10.2214/AJR.11.7866
  5. Petralia G, Padhani A, Summers P, Alessi S, Raimondi S, Testori A, Bellomi M. Whole-body diffusion-weighted imaging: is it all we need for detecting metastases in melanoma patients? Eur Radiol. 2013 Dec;23(12):3466-76. doi: 10.1007/s00330-013-2968-x.
    https://www.ncbi.nlm.nih.gov/pubmed/23884300
    https://link.springer.com/article/10.1007%2Fs00330-013-2968-x
  6. Yang HL, Liu T, Wang XM, Xu Y, Deng SM. Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol. 2011; 21:2604-17
    https://www.ncbi.nlm.nih.gov/pubmed/21887484
    https://link.springer.com/article/10.1007%2Fs00330-011-2221-4
  7. Li B, Li Q, Nie W, Liu S. Diagnostic value of whole-body diffusion-weighted magnetic resonance imaging for detection of primary and metastatic malignancies: A meta-analysis. Eur J Radiol. 2014; 83:338-44.
    https://www.ncbi.nlm.nih.gov/pubmed/24355655
    http://www.ejradiology.com/article/S0720-048X(13)00607-4/fulltext