Whole-Body MRI in Asymptomatic Individuals: Promise and Perils-AJR Expert Panel Review

This AJR Expert Panel Narrative Review examines current and emerging applications of whole-body MRI (WB-MRI) in asymptomatic individuals, addressing the examination's promise and pitfalls in context of available evidence. WB-MRI is being used in asymptomatic individuals primarily for multicancer detection, with research to date focusing on detection frequencies. Nononcologic applications include intracranial aneurysm detection, quantitative body composition analysis, and musculoskeletal assessment. Standardized acquisition and reporting frameworks and artificial intelligence workflows are being pursued to support WB-MRI implementation. WB-MRI is increasingly performed in the general population (i.e., individuals without cancer risk factors) as preventive healthcare, partly driven by a growing commercial market, despite limited evidence supporting clinical impact and lack of guidelines endorsing the practice. Moreover, WB-MRI carries potential harms from workup of indeterminate findings, overdiagnosis and overtreatment of indolent disease, and substantial direct and downstream costs. Additional ethical dilemmas relate to unregulated commercial advertising, appropriate informed consent, and psychosocial consequences. The article finally considers strategies to move the field forward, emphasizing the need for prospective trials assessing clinical benefit and cost-effectiveness, identification of potential intermediate-risk populations for targeted screening, and development of quality standards and communication models to ensure that WB-MRI evolves into a beneficial rather than harmful medical tool.