Streamlining staging of colorectal cancer with Whole Body MRI

Design: Multicentre, prospective diagnostic accuracy study

Aim:  This trial evaluated whether early whole-body MRI (WB-MRI) increased per patient sensitivity for metastasis in colorectal cancer compared to standard NICE-approved diagnostic pathways.

Key inclusion/exclusion criteria:
Inclusion:  Adult patients with histologically proven or suspected colorectal cancer referred for staging.
Suspicion of colorectal cancer.

Exclusion:  Evidence of severe or uncontrolled systemic disease
Contraindications to MRI
Polyp cancer

Primary outcome measure:  Per patient sensitivity for metastasis detection by whole body MRI (WB-MRI) compared to standard staging pathways in newly diagnosed colorectal cancer

Secondary outcome measures:
1. The time and test number taken to reach, and the nature of, the first major treatment decision based on WB-MRI in comparison to standard staging pathways.
2. Diagnostic accuracy of WB-MRI and conventional staging pathways for local tumour staging and detection of metastasis in comparison to an expert derived consensus reference standard.
3. Lifetime incremental cost and cost-effectiveness of staging using WB-MRI compared to standard diagnostic pathways.
4. Patient experience of staging using WB-MRI in comparison to standard diagnostic pathways and priorities placed by patients on differing attributes related to competing staging pathways.
5. Inter-observer variability in WB-MRI analysis and effect of diagnostic confidence on staging accuracy.
6. Diagnostic accuracy of limited T1 and diffusion weighted sequences compared to full multi-sequence WB-MRI protocols.

The STREAMLINE-C trial is reported here:


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