From Acquisition to Diagnosis: Why Accurate MRI Technique Determines Cancer Staging and Patient Outcomes

 

Michał Frączek, MD, PhD, EDIR

Department of Radiology, Radiotherapy and Nuclear Medicine

State Medical Institute of the Ministry of the Interior and Administration

 

Abstract:

Magnetic resonance imaging (MRI) is currently the cornerstone in the diagnosis and staging of many cancers. For the examination to have true clinical value, it must be performed in accordance with established standards. The quality of the images depends to a large extent on the radiographer’s work – they are responsible for proper acquisition, patient positioning, selection of parameters, and correct angulation of sequences. Inaccurate execution of the protocol, omission of essential sequences, or incorrect parameter settings may render the study non-diagnostic, preventing the radiologist from providing a reliable interpretation. Consequently, this may lead to inappropriate clinical management, directly affecting treatment outcomes and prognosis.

The aim of this presentation is to illustrate what the radiologist expects from the MRI technologist team. Clinical examples will be presented where the accuracy of sequence acquisition determines diagnostic reliability.

In prostate imaging, according to the PI-RADS system, high-quality T2-weighted sequences in three planes and diffusion-weighted imaging (DWI) with appropriately high b-values are crucial for evaluating the peripheral and transition zones. In rectal cancer, proper orientation of T2 sequences perpendicular to the tumor’s long axis is essential for precise assessment of depth of invasion, evaluation of the mesorectal fascia, and detection of lymph node involvement – factors that directly determine eligibility for surgical versus neoadjuvant treatment. In cervical and endometrial cancers, accurate T2 and DWI sequences allow assessment of local extension, infiltration of adjacent structures, and selection of patients for fertility-preserving strategies. In central nervous system tumors, mandatory sequences include DWI, T2, contrast-enhanced T1, and perfusion imaging, which together enable differentiation of neoplastic from inflammatory, vascular, or demyelinating lesions, as well as assessment of tumor grade.

This presentation is intended to emphasize that every aspect of the MRI examination – from patient positioning to technical details of each sequence – has a direct impact on diagnosis and subsequent treatment planning. Awareness of these dependencies, along with close collaboration between radiologist and radiographer, is fundamental for producing high-quality studies that directly influence patient safety and prognosis.