Whole-Body MRI Screening of Average Risk Populations: Promises and Controversies

Whole-body magnetic resonance imaging (WB-MRI) has attracted attention recently for multi-organ assessment. Although there is a body of literature on diagnostic performance as well as recommendations for use in particular high-risk subpopulations who require whole-body surveillance, WB-MRI has also entered the consumer market as a screening tool for average-risk individuals. For this latter purpose, there are proposed health-related benefits as well as controversies about the potential benefits and harms. The multi-disease screening of asymptomatic, average-risk groups with MRI, often with very low pre-test probability of clinically significant lesions or with limited detectability of disorders on imaging, signifies a major divergence from conventional screening principles. In some scenarios, it is plausible that WB-MRI improves disease detection and improves health outcomes, while lessening the inconvenience of multiple tests that each evaluate for a single-disease. However, the testing efficiency, clinical utility, and cost-effectiveness of large-scale implementation of screening WB-MRI are not established. In this narrative review, we highlight potential strengths and drawbacks based on the limited evidence to date. Awareness of the pathway for rigorous assessment of potential benefits and harms and current gaps in evidence may better guide research and inform implementation as interest in screening WB-MRI evolves. LEVEL OF EVIDENCE: 5. TECHNICAL EFFICACY: Stage 2.