Thursday, May 11, 2023

MEET PRENUVO: ADVANCED FULL BODY MRI FOR CANCER SCREENING & MONITORING

By: Lennard M. Gettz / NYCRA NEWS Editorial Team  

The NY Cancer Resource Alliance and HealthTech Reporter proudly introduces the latest installation of the Prenuvo clinic in New York City. All Prenuvo facilities offer the most current diagnostic advancement in whole body MRI imaging. Recognized for its volume of diagnostic-quality images acquired under one hour, Prenuvo's capacity to capture whole-body imaging through its unique, cutting edge analytic software offers a comprehensive array of next generation applications for early detection and real-time monitoring of complex diseases and cancers.  

On April 20, NYCRA NEWS conducted a special interview with DR. RAJ ATTARIWALA, Nuclear Medicine Radiologist, PhD Biomedical Engineer and  Founding Radiologist of Prenuvo. Known commonly as "Dr. Raj", he shares his commitment to improving on the current state of modalities in cancer diagnostics by offering  advancements on the performance, range and design of our current MRI technology.  

INTERVIEW PART 1: FROM CONCEPT TO DEVELOPMENT by Dr. Raj Attariwala
I bought my first MRI machine in 2009 and published my concepts about the very first whole body diffusion images at a conference called the International Society for Magnetic Residence and Medicine or ISMRM back in 2011. It was well received and led to an invited review on the topic in the Journal of MRI in 2013. The imaging society recognized this as a powerful and highly beneficial solution at a time when most facilities can only scan individual organs or body parts (ie. prostate, breast, chest, abdomen etc). Scanning the entire body is really challenging from an MRI hardware and software point of view because MRI machines and associated software were simply not designed to do that.  

The need 'to see more' has always been part of the diagnostic equation. In the field of nuclear medicine which looks at function of tissue, we often  scan the whole body when we inject a radioactive tracer, because you don't ever want to bring a patient back and re-inject them again. The beauty of MRI's absence of radiation and the ability to combine traditional anatomic (form) images with the power of functional imaging techniques invited the idea of covering more (actually the entirety) of the body without the need for any injection. I learned about the power of combining form and function years ago here in New York when I was training in the emerging field of PETCT at Memorial Sloan Kettering.

This collaboration cycle to build the whole body paradigm was a continuous process between MRI Physicists/ ENGINEERS and RADIOLOGISTS to expedite the design and prototyping stage. Having a doctorate in both fields made me the translator to both groups who commonly do not 'speak' the same language. Materializing concepts mean communicating  features radiologists need to see with those who could build programs and luckily, the progress became fairly streamlined and this process does not alter the FDA approval of a MRI.  


THE FULL-BODY STRATEGY FOR CANCER SCANNING
In simplistic terms, having a full-body access comports to the fact that everything is connected in one way or another.  Tumor cells start somewhere, but they can spread almost anywhere they want. If we find a cancer in stage one (which usually means confined to the organ of origin) what happens afterwards is to ask if it is IN FACT confined to that organ, or if it has spread somewhere else. This is called staging.

After a cancer is detected, patients often go into a panic asking "What stage is it? ... Is it metastatic?" Working with the conventional MRI or CT of the past, they would have to wait to get a brain MRI, then a chest, abdomen, pelvis study and a bone scan etc. With our technology, we already have all that. We've routinely found people with stage  one cancer as part of early detection. This is a good basis where you want to find it. From here, searching 'full  body' is the best next step to make sure that it's not anywhere else in the body. Using an MRI with diffusion, we can see it  all.  

An MRI is known as the most detailed imaging available for scanning a tumor anywhere in the body. Creating a treatment strategy becomes more effective when you know no areas have been overlooked. Patients and physicians both have a higher and more confident level of understanding about what they're dealing with. A great example is confirming that the pounding headache that a patient suffers from after a diagnosis of cancer is stress related, not due the fear of a metastasis...Whole body MRI coverage can preempt this concern.


REPLACING CONTRAST?
From a tumor perspective, you frequently get an increased number of cells which contributes to increased metabolism which often requires more energy. Injecting contrast – ie MRI gadolinium or CT iodine – ends up going to areas of increased blood flow where there is more energy needed, whereas FDG Positron Emission Tomography delivers increased glucose to the cells that are growing and have more energy demand. Instead of contrast our diffusion system works to track cellular density – whereby increased cellular density usually means a high concentration of cells (which is a tumor) which gives off a lot of signal. So as a result we're actually looking with diffusion at cells at a cellular level to see how dense (or hard) they  are. That's how we're able to characterize what the tissue is composed of with that functional diffusion sequence.  


COMMUNICATION TOOLS FOR EARLY DETECTION
Ideally, we want to find things in stage one, but the only way we can do that is to SCREEN. To create a full-body baseline scan of anyone offers a new layer of peace of mind whether we find something or not. In our decade long history, we have luckily found many early stage cancers in patients who were not expecting anything wrong – and this adds to the success and fortunately efficacy of the treatment phase.  

After a Prenuvo scan, diagnostic-quality images are provided to each patient, which are available for review between patient and physician. For those who receive a Prenuvo scan because of potential concerns, correlating what is on the images with their possible symptoms is a major benefit to confirming a disorder. If a patient has concerns of symptoms expressing  as night sweats, unusual weight loss, bone pain etc, a one hour Prenuvo scan can provide almost unequivocal imaging answers, or at the very least eliminates most major concerns and provide peace of mind, because with MRI we have looked through the entire body where the eyes cannot see.

Once an issue is identified, our radiology team communicates the report. For continuity of care, our team of health practitioners will go through and explain what's going on. If there's no  cancer per se, then the report goes directly to the patient with the findings combined with simplification of terms  so anyone can understand what it means. However if there is a finding, the scans directly go to a group of health practitioners who discuss next steps directly with that patient and ensure they're connected into the medical system. We remain involved with the entire patient journey and want to be part of the whole imaging continuity of  care  spectrum that the patient should have.






"CANCER DETECTIVE" FINDS GROUNDBREAKING SCAN

5/20- Dr. Bard receives the 2023
NY Cancer Resource Award 
On April 20th @ 4:30PM, Dr. Robert Bard scheduled his first FULL-BODY MRI on 312 West 34th Street.  Prior to its opening date on 4/27, PRENUVO welcomed special guests to test drive their cutting-edge imaging solution.  Positioned in NYC as the 8th installment is a significant landmark in Prenuvo's international footprint.  As a prominent figure in cancer diagnostic imaging and non-invasive research, Dr. Bard found great interest in experiencing this full-body innovation firsthand.
For over 3 decades, Dr. Bard has committed his life's work in the use and support of diagnostic imaging to detect cancer tumors. He is aligned with a global network of fellow cancer 'detectives' and clinical specialists.  He is often called to 'test drive' the latest ultrasound upgrades as part of developers' R&D, prior to market deployment. In addition, Dr. Bard is also a clinical researcher using ultrasound imaging to quantify therapeutic effects of non-invasive medical devices.

On April 27, 2023, Prenuvo officially announced the opening of their first New York City clinic. Founded in Vancouver, Canada, the company is recognized for their design of proactive whole-body imaging for the early detection of cancer and other diseases. With this expansion, New Yorkers will now have access to the fastest, safest, non-invasive whole-body screening on the market so that they can take personal control of their health and seek proactive solutions. [Source: Prenuvo press release]

PRENUVO REBOOTS HOLISTIC IMAGING WITH FULL BODY MRI By: Robert Bard, MD | Originally published in HealthTechReporter.com 

Unlike the many MRI's without contrast of almost every part of my body over the years, this was actually an interactive and possibly enjoyable experience. In addition to not having to worry about getting a contrast infusion, the fact that it was getting so much of the body minus the hands and feet offers an excellent overview. Because disease in one part of the body may cascade dysfunction in other parts of the body, the developers of this full body scan offers a diagnostic solution to address this. For example, a gallstone can drop into the pelvis, or an ovarian tumor can spread to the axilla or a melanoma of the calf can metastasize to the brain. The idea of full body imaging to rule out any kind of metastatic disease or primary disease like an aneurysm or an unsuspected kidney cancer is very important.

For such a comprehensive scan that takes a little more than an hour without any preparation is quite impressive to me.  In the case of abdominal imaging (specifically) for prostate studies, the fact that you don't need an enema or pre-op work is a major upgrade. Conducting a procedure becomes much easier due to the multiple areas of monitoring that are simultaneously available. This means you're getting more than one “workup”.

What I find special about the Prenuvo experience is that after the scan, you are contacted by a specialist who will explain the procedure and your imaging report.  For non-medical people, this process is invaluable. Also the video presentations of the pathology are placed before you in a three dimensional hologram- making it easy to navigate through the scans. 

Prenuvo promotes their technology as a PREVENTATIVE tool for anyone interested in a full-body view of their health.  This also works as part of an EARLY DETECTION protocol because the sooner you can catch something, the more time you have to address it- especially with cancers. Also, this is an advantage with inflammatory disease since psoriasis of the nail or the fingers can involve the joints anywhere in the body, especially in the pelvis and the sacroiliac joints. This would tell you if the treatment you are getting is responding slowing or if the progression is not working at all.  This full body scan offers a whole look at where the problem is and where it isn't and lets you confidently focus on the treatment technology in a more suitable direction.

INTELLIGENT SCAN FOR COMPLEX DISORDERS
Currently, the modern thinking of disease has changed. Something like psoriasis (a worldwide skin disease) not only affects the skin and the joints, but gives you an increased risk of stroke and cancer development. So when you get the full body scan, you check if your heart or brain are involved by the vasculitis. This is an inflammatory disease- and because it's a whole body disorder, we want to treat the whole body. As a matter of fact, it makes sense to scan the whole body first- making the Prenuvo ideal for producing a proper base line. 

The same thing goes with metastatic cancer. You need to see where it is, where it's going to and where it hasn't gone to. The conundrum occurs with a tumor vs. the inflammation that usually appears with a tumor. We are seeing this more often- where a large cancer is actually part-cancer, part scarring fibrosis and part-inflammation.  In other words, what you see and feel isn't necessarily disease. Through advanced imaging, you may distinguish suspicious tissue from fibrosis, an inflammatory tissue or cancer which is where the ultrasound compliments the full body imaging.




TECH TALK: PRENUVO'S UNIQUE APPROACH TO WB-MRI

MRI technology has now matured over the past 20-years where we can actually effectively perform diagnostic-quality WB-MRI. Via careful MRI protocol design and optimization, we have developed a specialized WB-MRI focused screening service that has been of significant clinical utility to our patients and referring-clinician colleagues. 

Our approach to whole-body MRI imaging is one that is geared for early detection, fast yet comprehensive, safe and comfortable. Our standard Prenuvo screening protocol is a comprehensive multiparametric Whole-Body MRI study (anatomically covering the head, neck, chest, abdomen, pelvis, whole-spine, and lower-extremities through the ankles)  that takes under 1 hour without compromising diagnostic quality. This technique is effective to detect, localize, characterize, and even stage a very wide-spectrum of pathology (ranging from solid-tumors even at small early/localized stages, to benign cysts, to brain aneurysms, and many other diverse pathologies) with a very high-level of sensitivity and specificity for a screening evaluation.  We do this without undesirable radiation or contrast. 

What makes our approach different from traditional MRI approaches, which typically rely primarily on more anatomically-focused imaging, is that we also combine this with an important specialized functional-focused MRI-technique known as Diffusion-Weighted-Imaging (DWI) covering the whole body. DWI has been clinically-demonstrated to play a very valuable role particularly in oncological-imaging; and, in the screening setting DWI significantly enhances  our ability to discriminate oncologically-concerning lesions from benign lesions. DWI can be thought of as an MRI-analogue to PET-imaging (whereas PET highlights hypermetabolism of cancerous tissue, DWI highlights hypercellular-density or “tissue hardness” characteristic of cancerous tissue). 

Our DWI technique, in conjunction with the multiple other well established multiplanar multiparametric MRI sequences in our protocol, afford us the requisite level of sensitivity and specificity needed to provide clinical value in the context of desired proactive screening. Most standard MRI systems are not capable of performing these specialized WB-MRI sequences at an acceptable speed, image resolution, and similar multiparametric comprehensiveness. 

MRI SCREENING vs HOSPITAL CONVENTION-  Prenuvo scans capture 2000 images in 28 areas in under an hour at diagnostic quality, with 1B+ data points acquired, compared to the 4-5 hours it would take through conventional MRI. Conventional MRIs also use pre-programmed protocols that are not optimized for whole-body speed capture without compromising diagnostic quality. We've taken a different approach and verticalized our hardware and designed software acquisition protocols for whole-body diagnostic yield in under one hour.  





















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