The purpose of this recommendation of the Oncology Task Force of the European Society of Paediatric Radiology (ESPR) is to indicate reasonable applications of whole-body MRI in children with cancer and to address useful protocols to optimize workflow and diagnostic performance. Whole-body MRI as a radiation-free modality has been increasingly performed over the last two decades, and newer applications, as in screening of children with germ-line mutation cancer-related gene defects, are now widely accepted. We aim to provide a comprehensive outline of the diagnostic value for use in daily practice. Based on the results of our task force session in 2018 and the revision in 2019 during the ESPR meeting, we summarized our group's experiences in whole-body MRI. The lack of large evidence by clinical studies is challenging when focusing on a balanced view regarding the impact of whole-body MRI in pediatric oncology. Therefore, the final version of this recommendation was supported by the members of Oncology Task Force.

Department of Paediatric Radiology IRCCS materno infantile Burlo Garofolo Trieste Italy

Department of Pediatric Radiology Charles University and Motol University Hospital Prague Czech Republic

Department of Pediatric Radiology Olgahospital Klinikum Stuttgart Stuttgart Germany

Department of Radiology and Nuclear Medicine Princess Maxima Center for Pediatric Oncology Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands

Division of Pediatric Radiology Department of Radiology University Hospital of Tübingen Hoppe Seyler Straße 3 72076 Tübingen Germany

Radiology Clinic Sarajevo School of Science and Technology Clinical Center University of Sarajevo Sarajevo Bosnia and Herzegovina

Radiology Department Bambino Gesù Children's Hospital Rome Italy

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Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol. 2001;177:229–236. PubMed

Kellenberger CJ, Miller SF, Khan M, et al. Initial experience with FSE STIR whole-body MR imaging for staging lymphoma in children. Eur Radiol. 2004;14:1829–1841. PubMed

Goo HW, Yang DH, Ra YS, et al. Whole-body MRI of Langerhans cell histiocytosis: comparison with radiography and bone scintigraphy. Pediatr Radiol. 2006;36:1019–1031. PubMed

Schaefer JF, Schlemmer HP. Total-body MR-imaging in oncology. Eur Radiol. 2006;16:2000–2015. PubMed

Burdach S, Thiel U, Schoniger M, et al. Total body MRI-governed involved compartment irradiation combined with high-dose chemotherapy and stem cell rescue improves long-term survival in Ewing tumor patients with multiple primary bone metastases. Bone Marrow Transplant. 2010;45:483–489. PubMed

Kwee TC, Takahara T, Vermoolen MA, et al. Whole-body diffusion-weighted imaging for staging malignant lymphoma in children. Pediatr Radiol. 2010;40:1592–1602. PubMed PMC

Siegel MJ, Acharyya S, Hoffer FA, et al. Whole-body MR imaging for staging of malignant tumors in pediatric patients: results of the American College of Radiology Imaging Network 6660 trial. Radiology. 2013;266:599–609. PubMed PMC

Littooij AS, Kwee TC, Barber I, et al. Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard. Eur Radiol. 2014;24:1153–1165. PubMed

Littooij AS, Kwee TC, de Keizer B, et al. Whole-body MRI-DWI for assessment of residual disease after completion of therapy in lymphoma: a prospective multicenter study. J Magn Reson Imaging. 2015;42:1646–1655. PubMed

Damasio MB, Magnaguagno F, Stagnaro G. Whole-body MRI: non-oncological applications in paediatrics. Radiol Med. 2016;121:454–461. PubMed

Ballinger ML, Best A, Mai PL, et al. Baseline surveillance in Li-Fraumeni syndrome using whole-body magnetic resonance imaging: a meta-analysis. JAMA Oncol. 2017;3:1634–1639. PubMed PMC

Albano D, Patti C, Matranga D, et al. Whole-body diffusion-weighted MR and FDG-PET/CT in Hodgkin lymphoma: predictive role before treatment and early assessment after two courses of ABVD. Eur J Radiol. 2018;103:90–98. PubMed

Schaefer JF, Berthold LD, Hahn G, et al. Whole-body MRI in children and adolescents — S1 guideline. Rofo. 2019;191:618–625. PubMed

Kellenberger CJ, Epelman M, Miller SF, Babyn PS. Fast STIR whole-body MR imaging in children. Radiographics. 2004;24:1317–1330. PubMed

Mentzel HJ, Kentouche K, Sauner D, et al. Comparison of whole-body STIR-MRI and 99mTc-methylene-diphosphonate scintigraphy in children with suspected multifocal bone lesions. Eur Radiol. 2004;14:2297–2302. PubMed

Goo HW. Regional and whole-body imaging in pediatric oncology. Pediatr Radiol. 2011;41:S186–S194. PubMed

Greer MC. Whole-body magnetic resonance imaging: techniques and non-oncologic indications. Pediatr Radiol. 2018;48:1348–1363. PubMed

Ley S, Ley-Zaporozhan J, Schenk JP. Whole-body MRI in the pediatric patient. Eur J Radiol. 2009;70:442–451. PubMed

Ishiguchi H, Ito S, Kato K, et al. Diagnostic performance of (18)F-FDG PET/CT and whole-body diffusion-weighted imaging with background body suppression (DWIBS) in detection of lymph node and bone metastases from pediatric neuroblastoma. Ann Nucl Med. 2018;32:348–362. PubMed PMC

Klenk C, Gawande R, Uslu L, et al. Ionising radiation-free whole-body MRI versus (18)F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer: a prospective, non-randomised, single-centre study. Lancet Oncol. 2014;15:275–285. PubMed

Punwani S, Prakash V, Bainbridge A, et al. Quantitative diffusion weighted MRI: a functional biomarker of nodal disease in Hodgkin lymphoma? Cancer Biomark. 2010;7:249–259. PubMed

Wu X, Pertovaara H, Dastidar P, et al. ADC measurements in diffuse large b-cell lymphoma and follicular lymphoma: a DWI and cellularity study. Eur J Radiol. 2013;82:e158–e164. PubMed

Punwani S, Cheung KK, Skipper N, et al. Dynamic contrast-enhanced MRI improves accuracy for detecting focal splenic involvement in children and adolescents with Hodgkin disease. Pediatr Radiol. 2013;43:941–949. PubMed

Raissaki M, Demetriou S, Spanakis K, et al. Multifocal bone and bone marrow lesions in children — MRI findings. Pediatr Radiol. 2017;47:342–360. PubMed

Steinborn M, Wortler K, Nathrath M, et al. Whole-body MRI in children with Langerhans cell histiocytosis for the evaluation of the skeletal system. Rofo. 2008;180:646–653. PubMed

Smets AM, Deurloo EE, Slager TJE, et al. Whole-body magnetic resonance imaging for detection of skeletal metastases in children and young people with primary solid tumors — systematic review. Pediatr Radiol. 2018;48:241–252. PubMed PMC

Kumar J, Seith A, Kumar A, et al. Whole-body MR imaging with the use of parallel imaging for detection of skeletal metastases in pediatric patients with small-cell neoplasms: comparison with skeletal scintigraphy and FDG PET/CT. Pediatr Radiol. 2008;38:953–962. PubMed

Krohmer S, Sorge I, Krausse A, et al. Whole-body MRI for primary evaluation of malignant disease in children. Eur J Radiol. 2010;74:256–261. PubMed

Punwani S, Taylor SA, Bainbridge A, et al. Pediatric and adolescent lymphoma: comparison of whole-body STIR half-Fourier RARE MR imaging with an enhanced PET/CT reference for initial staging. Radiology. 2010;255:182–190. PubMed

Regacini R, Puchnick A, Luisi FAV, Lederman HM. Can diffusion-weighted whole-body MRI replace contrast-enhanced CT for initial staging of Hodgkin lymphoma in children and adolescents? Pediatr Radiol. 2018;48:638–647. PubMed

Anupindi SA, Bedoya MA, Lindell RB, et al. Diagnostic performance of whole-body MRI as a tool for cancer screening in children with genetic cancer-predisposing conditions. AJR Am J Roentgenol. 2015;205:400–408. PubMed

Benusiglio PR, Brugieres L, Caron O. Whole-body MRI screening in children with Li-Fraumeni and other cancer predisposition syndromes. AJR Am J Roentgenol. 2016;206:W52. PubMed

Bojadzieva J, Amini B, Day SF, et al. Whole body magnetic resonance imaging (WB-MRI) and brain MRI baseline surveillance in TP53 germline mutation carriers: experience from the Li-Fraumeni syndrome education and early detection (LEAD) clinic. Familial Cancer. 2017;17:287–294. PubMed

O'Neill AF, Voss SD, Jagannathan JP et al (2018) Screening with whole-body magnetic resonance imaging in pediatric subjects with Li-Fraumeni syndrome: a single institution pilot study. Pediatr Blood Cancer 65 PubMed

Mautner VF, Asuagbor FA, Dombi E, et al. Assessment of benign tumor burden by whole-body MRI in patients with Neurofibromatosis 1. Neuro Oncol. 2008;10:593–598. PubMed PMC

Nguyen R, Jett K, Harris GJ et al (2014) Benign whole body tumor volume is a risk factor for malignant peripheral nerve sheath tumors in neurofibromatosis type 1. J Neurooncol 116:307–313 PubMed

Evans DGR, Salvador H, Chang VY. Cancer and central nervous system tumor surveillance in pediatric Neurofibromatosis 1. Clin Cancer Res. 2017;23:e46–e53. PubMed

Friedman DN, Lis E, Sklar CA, et al. Whole-body magnetic resonance imaging (WB-MRI) as surveillance for subsequent malignancies in survivors of hereditary retinoblastoma: a pilot study. Pediatr Blood Cancer. 2014;61:1440–1444. PubMed PMC

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29. PubMed

Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059–3068. PubMed PMC

Rosolen A, Perkins SL, Pinkerton CR, et al. Revised international pediatric non-Hodgkin lymphoma staging system. J Clin Oncol. 2015;33:2112–2118. PubMed PMC

Latifoltojar A, Punwani S, Lopes A. Whole-body MRI for staging and interim response monitoring in paediatric and adolescent Hodgkin's lymphoma: a comparison with multi-modality reference standard including (18)F-FDG-PET-CT. Eur Radiol. 2019;29:202–212. PubMed PMC

Mayerhoefer ME, Karanikas G, Kletter K. Evaluation of diffusion-weighted magnetic resonance imaging for follow-up and treatment response assessment of lymphoma: results of an 18F-FDG-PET/CT-controlled prospective study in 64 patients. Clin Cancer Res. 2015;21:2506–2513. PubMed

Lin C, Itti E, Luciani A, et al. Whole-body diffusion-weighted imaging with apparent diffusion coefficient mapping for treatment response assessment in patients with diffuse large B-cell lymphoma: pilot study. Investig Radiol. 2011;46:341–349. PubMed

Meyer JS, Siegel MJ, Farooqui SO, et al. Which MRI sequence of the spine best reveals bone-marrow metastases of neuroblastoma? Pediatr Radiol. 2005;35:778–785. PubMed

Papaioannou G, McHugh K. Neuroblastoma in childhood: review and radiological findings. Cancer Imaging. 2005;5:116–127. PubMed PMC

Monclair T, Brodeur GM, Ambros PF et al (2009) The International Neuroblastoma Risk Group (INRG) staging system: an INRG task force report. J Clin Oncol 27:298–303 PubMed PMC

Pfluger T, Schmied C, Porn U, et al. Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma. AJR Am J Roentgenol. 2003;181:1115–1124. PubMed

Kembhavi SA, Rangarajan V, Shah S, et al. Prospective observational study on diagnostic accuracy of whole-body MRI in solid small round cell tumours. Clin Radiol. 2014;69:900–908. PubMed

Peschmann AL, Beer M, Ammann B, et al. Quantitative DWI predicts event-free survival in children with neuroblastic tumours: preliminary findings from a retrospective cohort study. Eur Radiol Exp. 2019;3:6. PubMed PMC

Casali PG, Abecassis N, Aro HT et al (2018) Soft tissue and visceral sarcomas: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 29:iv268–iv269 PubMed

Casali PG, Bielack S, Abecassis N et al (2018) Bone sarcomas: ESMO-PaedCan-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 29:iv79–iv95 PubMed

Ben Arush M, Minard-Colin V, Mosseri V, et al. Does aggressive local treatment have an impact on survival in children with metastatic rhabdomyosarcoma? Eur J Cancer. 2015;51:193–201. PubMed

Federico SM, Spunt SL, Krasin MJ, et al. Comparison of PET-CT and conventional imaging in staging pediatric rhabdomyosarcoma. Pediatr Blood Cancer. 2013;60:1128–1134. PubMed PMC

Scheer M, Dantonello T, Brossart P, et al. Importance of whole-body imaging with complete coverage of hands and feet in alveolar rhabdomyosarcoma staging. Pediatr Radiol. 2018;48:648–657. PubMed

Goo HW, Choi SH, Ghim T, et al. Whole-body MRI of paediatric malignant tumours: comparison with conventional oncological imaging methods. Pediatr Radiol. 2005;35:766–773. PubMed

Norman G, Fayter D, Lewis-Light K, et al. Mind the gap: extent of use of diffusion-weighted MRI in children with rhabdomyosarcoma. Pediatr Radiol. 2015;45:778–781. PubMed

Kubo T, Furuta T, Johan MP, et al. Value of diffusion-weighted imaging for evaluating chemotherapy response in osteosarcoma: a meta-analysis. Mol Clin Oncol. 2017;7:88–92. PubMed PMC

Morimoto A. Langerhans cell histiocytosis. In: Ishii E, editor. Hematological disorders in children: pathogenesis and treatment. Singapore: Springer; 2017.

Kim JR, Yoon HM, Jung AY, et al. Comparison of whole-body MRI, bone scan, and radiographic skeletal survey for lesion detection and risk stratification of Langerhans cell histiocytosis. Sci Rep. 2019;9:317. PubMed PMC

Laffan EE, O'Connor R, Ryan SP, Donoghue VB. Whole-body magnetic resonance imaging: a useful additional sequence in paediatric imaging. Pediatr Radiol. 2004;34:472–480. PubMed

Mueller WP, Melzer HI, Schmid I, et al. The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis. Eur J Nucl Med Mol Imaging. 2013;40:356–363. PubMed

Robson ME, Bradbury AR, Arun B, et al. American Society of Clinical Oncology policy statement update: genetic and genomic testing for cancer susceptibility. J Clin Oncol. 2015;33:3660–3667. PubMed

Greer MC. Imaging of cancer predisposition syndromes. Pediatr Radiol. 2018;48:1364–1375. PubMed

Villani A, Shore A, Wasserman JD, et al. Biochemical and imaging surveillance in germline TP53 mutation carriers with li-Fraumeni syndrome: 11 year follow-up of a prospective observational study. Lancet Oncol. 2016;17:1295–1305. PubMed

Kamihara J, Bourdeaut F, Foulkes WD, et al. Retinoblastoma and neuroblastoma predisposition and surveillance. Clin Cancer Res. 2017;23:e98–e106. PubMed PMC

Darge K, Jaramillo D, Siegel MJ. Whole-body MRI in children: current status and future applications. Eur J Radiol. 2008;68:289–298. PubMed

Schaefer JF, Kramer U. Whole-body MRI in children and juveniles. Rofo. 2011;183:24–36. PubMed

Eutsler EP, Khanna G. Whole-body magnetic resonance imaging in children: technique and clinical applications. Pediatr Radiol. 2016;46:858–872. PubMed

Olsen OE. Practical body MRI — a paediatric perspective. Eur J Radiol. 2008;68:299–308. PubMed