TOPLINE:

A novel shortened MRI protocol achieved 100% detection of malignant lesions in patients with Li-Fraumeni syndrome (LFS), while reducing the scan time by more than 50%. The abbreviated protocol maintained high accuracy with an overall lesion detection of 94.3% and only 3.6% of false positives.

METHODOLOGY:

• Researchers conducted a prospective bicentric study involving 113 participants with LFS who underwent 189 whole-body MRI (WB-MRI) examinations between 2020 and 2022.
• The comprehensive original protocol included different MRI sequences: coronal turbo inversion recovery magnitude, coronal T1-weighted (T1) sequence, axial fluid-attenuated inversion recovery (FLAIR; head only), axial T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE), axial diffusion-weighted imaging (DWI), an axial apparent diffusion coefficient map, and axial T1-Dixon water-only images before the contrast agent and a repeat after the administration of the contrast agent.
• The visibility of lesions, including 38 malignant findings, was independently scored by three radiologists using a 5-point Likert scale.
• Different sequence combinations were compared to find the minimum protocol, ensuring that all malignant lesions were classified as "easily detectable."

TAKEAWAY:

• A shortened, contrast agent-free WB-MRI protocol combining cranial FLAIR, WB-DWI, and WB-HASTE enabled 100% detection of all new malignant lesions.
• This optimal three-sequence protocol reduced the total acquisition time by over 50% compared to the original comprehensive protocol (from 77.5 to 36.5 minutes).
• DWI showed the best individual detection performance, classifying 86.0% of malignant lesions as "easily detectable" across the entire body.
• Overall detection accuracy reached 94.3% for all lesions and 87.5% for suspicious lesions, with a false-positive rate of 3.6% in inconspicuous examinations.

IN PRACTICE:

"An abbreviated MRI protocol including the combination of axial FLAIR (head) with axial HASTE and DWI (head to thigh) offers an effective, contrast-agent-free approach for cancer detection in individuals with LFS," the authors wrote. "Such a protocol could balance high sensitivity, a reduced duration, and patient safety, making it suitable for long-term annual surveillance. Further studies should aim to assess the utility of the abbreviated protocol with regard to lesion detection, patient stress, and specificity," they added.

SOURCE:

This study was led by Myriam Margareta Keymling, German Cancer Research Center, Heidelberg, Germany. It was published online on October 21, 2025, in European Radiology.

LIMITATIONS:

Despite the large cohort size for this rare condition, the relatively small number of malignancies limited statistical robustness, particularly given the diverse tumour spectrum in LFS. This study did not capture certain core spectrum tumours like osteosarcomas during the study period, potentially affecting sequence evaluation results. Reader bias was another limitation as radiologists were aware of lesion locations before visibility scoring.

DISCLOSURES:

This study was funded by the German Federal Ministry of Education and Research. One author reported receiving lecture fees and project support from Siemens Healthineers unrelated to this work. Two authors reported holding editorial positions in the publishing journal.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.