MRI for Bone Cancer Detection

Introduction

Bone tumours can replace bone marrow long before structural changes occur¹. Therefore, waiting for X-ray findings may risk discovering the cancer too late. Magnetic Resonance Imaging (MRI) is a sophisticated technology that is excellent for detecting bone cancers due to its superior soft tissue contrast and ability to visualise bone marrow abnormalities before structural changes occur in the bone. 

Its high sensitivity (91-95 per cent) and specificity (95-97 per cent) for detecting bone tumours, combined with the capability to delineate tumour extent and relation to surrounding structures, alongside its sensitivity to T1 marrow signal loss and oedema (swelling) due to fluid buildup, make MRI the imaging method of choice for comprehensive evaluation of primary bone cancers and metastases^2–4. 

Whole-body MRI, particularly with diffusion-weighted imaging (DWI), demonstrates superior or comparable sensitivity and specificity for detecting missed metastases compared to other imaging modalities such as bone scintigraphy (BS) and conventional radiography⁵. Rapid diagnosis accelerates care, leading to timely biopsy, treatment, or surgery, which are critical for improving the survival rate.

Why You Might Need a Bone MRI

A bone MRI is often recommended when a person experiences persistent, unexplained bone pain or swelling, especially near a joint or growth plate, or if other scans, such as X-rays or computed tomography (CT), reveal abnormalities that could involve the bone marrow, such as a tumour or infection^6,7.

It is also used before surgery or chemotherapy to map the extent of a tumour into surrounding soft tissue and to check for additional lesions in the same bone⁸. Furthermore, it can be used to monitor the effectiveness of treatment by looking for changes, such as new healthy marrow or signs of tumour cell death⁹. 

Unlike X-rays or CT scans, MRI provides detailed images of both bone and soft tissue without using radiation, making it especially useful for diagnosing injuries, infections, tumours, and other bone or joint problems¹⁰.

How To Prepare for Your Bone MRI

Here are a few tips to help you prepare for your MRI¹¹:

• Take your usual medications and eat normally, unless instructed to fast for sedation or contrast. Avoid heavy caffeine intake and stay hydrated.
• Inform staff about any metal implants or devices, and bring safety cards for “MR-Conditional” implants, such as pacemakers or aneurysm clips.
• Remove all metal items, including jewellery, hairpins, dental plates, and transdermal patches with foil, to prevent image distortion.
• Bring your referral, prior brain images, and insurance pre-authorisation to avoid delays.
• Wear comfortable, metal-free clothing; ask about earplugs, music, or mirror goggles if you’re claustrophobic.
• If contrast is planned, fast for 4–6 hours prior to the procedure. Inform staff about any kidney issues or past reactions to contrast agents, as safer alternatives may be available.
• Arrange an escort home if you need sedation for claustrophobia.

You can read more about preparation for Ezra’s Full Body Scan here.

What Happens During the Bone Scan?

Upon arrival for your MRI, you will need to check in and complete a screening form. This will allow you to confirm the presence of implants, allergies, and whether you might need any anxiety medication.

During the scan, you will lie down on a sliding table. A dedicated surface or phased-array coil is typically placed over the limb or region of interest¹². Your head will be nestled in a small cushion that will keep you still. The scan typically lasts 30-45 minutes of actual “table time”, during which the technician may acquire multiple sequences (settings), including T1, T2/STIR, fat-suppressed post contrast, and DWI¹³. Expect loud knocking noises (up to 110 dB); earplugs or headphones are provided to reduce discomfort. It’s normal to feel mild table vibrations.

You’ll stay in touch with the team via a two-way intercom and a squeeze bulb, allowing you to communicate or pause the scan if needed. If contrast is required, it’s injected halfway through, possibly causing a brief cool sensation. After the final sequence, the coil is removed, and you’re free to go. 

At Ezra, our Full Body Plus scan takes around 60 minutes total, with 45 minutes of table time. Earplugs or headphones are available.

After the scan, you will be contacted by a medical provider working with Ezra within roughly a week. On the day of the appointment, you will receive a copy of your report and access to your scanned images through the online portal.

MRI Safety, Risks, & Side-Effects

MRI is generally considered very safe when proper screening and protocols are followed, but certain risks and side effects should be understood:

• Metal and implants: The strong 3-Tesla magnet can pull or heat older pacemakers, aneurysm clips, or metal fragments¹⁴. Most modern “MR-Conditional” devices (like cochlear implants or pain pumps) are safe after screening, but all implants must be checked before scanning¹⁵.
• Gadolinium contrast: Macrocyclic gadolinium agents (e.g., gadobutrol) have an extremely low risk of allergic reactions or nephrogenic systemic fibrosis (NSF) when kidneys are healthy¹⁶. However, gadolinium can accumulate in tissues, and rare side effects such as headaches or skin changes have been reported. Many centres now offer contrast-free alternatives for routine follow-up¹⁷. You can read more about gadolinium contrast side effects here.
• Incidental findings: Incidental bone lesions are discovered on imaging in approximately 2 to 10 per cent of cases, but the vast majority are benign and require only observation or serial imaging rather than immediate intervention¹⁸.
• Claustrophobia: Anxiety inside the scanner is common. Wide-bore scanners, music, mirror goggles, or a single dose of oral sedative can help alleviate symptoms. Open MRI is an option if image detail can be sacrificed.
• Zero Ionising Radiation: MRI uses magnetic fields and radio waves, not X-rays, so there is no ionising radiation exposure, making it safer for repeated scans compared to CT scans¹⁹.
• Minor Sensations: Expect loud knocking, mild table vibration, and a brief cool flush if contrast is injected. Rare side effects include headaches, fatigue, or mild skin heating.

A deeper dive into possible side effects (such as heat, headaches, and gadolinium deposition) is available in our full guide.

At Ezra, we employ a contrast-free approach using wide-bore T3 machines to deliver a comfortable scanning experience.

Terms You Might See in Your MRI Report (And What They Mean)

There are a number of terms you might see in your MRI report after your brain scan. Here are some explanations for some common ones:

Intramedullary Extent: This refers to the extent to which the tumour has spread within the bone marrow cavity, which MRI measures precisely to help surgeons plan the most effective treatment approach⁴.

Cortical breach/destruction: Cortical breach means the tumour has broken through the hard outer shell of the bone, a sign of more aggressive disease that MRI can detect by showing gaps or thinning in the bone’s cortex²⁰.

Soft-tissue extension: This describes when the tumour has grown beyond the bone into nearby muscles or tissues, which MRI reveals as a mass outside the bone’s surface⁴. 

Periosteal reaction: Periosteal reaction is a pattern of new bone growth on the bone’s surface, such as “lamellated”, “spiculated”, or “Codman triangle”, which MRI can identify and classify to help determine how aggressive the tumour is²¹.

ADC (Apparent Diffusion Coefficient): ADC is a measurement from diffusion MRI that reflects the density of tumour cells; lower ADC values suggest the tumour is more cellular and likely malignant²².

Necrosis %: Necrosis percentage shows how much of the tumour is dead after chemotherapy, with MRI estimating this by measuring the non-enhancing (non-contrast-taking) areas²³. Higher necrosis generally means a better response to treatment.

Skip lesion: A skip lesion is a separate area of tumour in the same bone but away from the main tumour, which MRI can detect. Finding these is important for complete surgical removal and accurate staging.

Ezra provides a radiologist-reviewed report in a non-technical and easy-to-understand format on your dashboard²⁴.

After the MRI Scan

After the MRI scan, you will be free to go home and continue with your day without any precautions²⁵. If you received a sedative, you will need another person to pick you up. You will also not be able to drive, consume alcohol or operate heavy machinery 24 hours after the sedative. 

A team of experts will review your results and determine whether a follow-up is necessary and recommend the appropriate treatment if needed. If abnormalities are found, you may undergo ongoing monitoring every 2-3 months to track recurrence. You can receive support in the form of counselling and advice on how to handle aspects like claustrophobia. 

If you have a scan with us here at Ezra, you will receive your report within five to seven days and have the option to discuss it with a medical practitioner. You can also access your scan images through the online portal.

What MRI Can Show About Bone Cancer

MRI is highly effective for evaluating bone cancer because it precisely shows the length and volume of the tumour, including how far it spreads inside the bone marrow (intramedullary spread) and whether it extends into nearby soft tissues²⁶. This accuracy is crucial for planning limb-sparing surgeries, as MRI measurements of tumour boundaries closely correlate with what is found during surgery, allowing surgeons to determine safe margins for removing the tumour. MRI is also superior to other imaging methods for detecting subtle or early bone lesions, especially when radiographs or CT scans are inconclusive^2,4.

In addition to mapping tumour size, MRI can distinguish between cortical destruction and an intact but thinned cortex, which is key for surgical decision-making²⁶. It also shows the tumour’s relationship to important structures, such as nerves, blood vessels, and the joint capsule, helping surgeons avoid critical areas and achieve clear margins. MRI can detect periosteal reactions, such as laminated, sunburst, or Codman triangle patterns, that suggest tumour grade and aggressiveness, with diagnostic performance comparable to conventional radiography²¹.

MRI further shows soft tissue oedema (swelling) and areas of diffusion restriction (low ADC values), which indicate high tumour cell density and help differentiate malignant from benign lesions²⁷. These imaging features not only guide diagnosis but also allow for monitoring how well the tumour responds to treatments, such as chemotherapy, by tracking changes in marrow signal and the percentage of tumour necrosis².

Types of Bone Tumours and How They Look on MRI

• Conventional osteosarcoma often appears on MRI as a dark (low signal) mass on T1 and bright (high signal) on T2, with aggressive features such as a “sunburst” pattern of new bone, a cloud-like mineral matrix, and areas that enhance unevenly after contrast, all signs of a rapidly growing bone tumour²⁸.
• Ewing sarcoma typically presents as a large area of low signal on T1-weighted images with significant soft-tissue swelling, often displaying “onion-skin” layers of new bone on the outside and a very bright signal on diffusion-weighted scans, indicating a highly cellular tumour.

• Chondrosarcoma is recognised by its lobulated, very bright (hyperintense) appearance on T2 MRI and a distinctive “ring-and-arc” pattern in the cartilage matrix, sometimes with well-defined edges that help set it apart from other tumours^29,30.
• Bone metastasis (such as from breast or prostate cancer) typically looks like one or more dark (hypointense) spots on T1 MRI, may enhance after contrast, and can sometimes be associated with a broken bone (pathological fracture)³¹.‍
• Telangiectatic osteosarcoma is characterised by large, blood-filled spaces within the tumour that create fluid-fluid levels on MRI, thin enhancing walls or septa, and aggressive destruction of the bone’s outer layer^32,33.

Ezra screens for over 500 conditions in 13 organs, including the spine. 

Types of MRI Scans Used in Bone Cancer Detection

There are multiple types of MRI scans, all using different methods to give a better visualisation of bone tumours. 

• Regional high-resolution MRI focuses on a specific region, such as a limb or part of the spine, to provide detailed images of a suspected bone tumour, helping doctors see exactly how far the cancer has spread locally and plan surgery or other treatments⁴.
• Whole-body MRI (WB-MRI) scans your entire skeleton in one session, allowing doctors to check for bone cancer that may have spread or to spot other tumours elsewhere in the body, making it useful for staging and follow-up³⁴.
• DWI/ADC mapping utilises specialised MRI techniques to measure the density of tumour cells; this helps determine if a tumour is more likely to be cancerous and can also indicate how well it’s responding to chemotherapy³⁵.
• Dynamic contrast-enhanced (DCE) MRI tracks how quickly a contrast dye moves in and out of the tumour, creating curves that show the amount of blood supply the tumour has, which can help determine its aggressiveness²⁴. 
• MR angiography provides a detailed look at the blood vessels near the tumour, which is especially important if the cancer is close to major arteries, helping surgeons plan safe removal of the tumour³⁶.

Ezra uses whole-body DWI imaging to get a full picture of the body and catch any potential abnormalities.

MRI vs. Other Imaging Tests for Bone Cancer Detection

MRI Scan Cost

MRI costs vary depending on factors like scan type, facility, location, and insurance coverage. Hospital-based MRIs are generally more expensive than those at independent imaging centres. Patients can save money by comparing prices, exploring cash payment discounts, and utilising insurance benefits or financial assistance programs. 

At Ezra, you can get a Full-Body Plus MRI for the all-inclusive price of £2395. This is a 60-minute MRI, after which you will be provided with a medical practitioner to help you understand your results. We have a location in London, with further locations across the UK coming soon.

Frequently Asked Questions

What is the best scan to detect bone cancer?

‍MRI is often the best scan for detecting and precisely assessing bone cancer, as it provides detailed images of bone and surrounding tissues and can help distinguish tumours from other causes of bone changes.

Can a hip MRI show cancer?

‍Yes, a hip MRI can detect both benign and malignant tumours in the hip area, as well as show their size, extent, and relationship to nearby structures.

Bone scan vs MRI for cancer?

‍MRI is generally more accurate than a bone scan for diagnosing bone cancer and assessing its local extent, while a bone scan is better for screening the whole skeleton for cancer spread.

Can an X-ray show cancer in the bones?

‍X-rays are a common first step and can often reveal bone cancer as ragged or abnormal areas, but further tests like MRI or biopsy are usually needed to confirm the diagnosis.

Why would a doctor order a bone scan after an MRI?

‍A doctor may order a bone scan after an MRI to check for cancer that has spread to other bones or to investigate unexplained bone pain when MRI or X-ray results are inconclusive.

Key Takeaways

• MRI can detect disease in the bone marrow earlier than X-ray or CT, with T1 dark marrow and possible STIR oedema appearing weeks before other imaging changes.
• Diffusion-weighted imaging (DWI) highlights tumours with high cellularity, and low ADC values can reveal cancers, such as Ewing sarcoma or lymphoma, even when the bone cortex is still intact.
• Whole-body MRI helps prevent understaging by detecting “skip” lesions or early bone metastases that might be missed by other tests in a single comprehensive scan.
• Areas of contrast uptake on MRI indicate viable tumour tissue, and early, uneven enhancement can help pinpoint the most aggressive areas for biopsy.
• Getting an MRI promptly can make limb-sparing surgery possible, as finding cancer before it invades nerves or the bone’s outer layer greatly improves treatment options and survival.

Ready to take proactive steps for your health? Book an Ezra full-body MRI today to detect any issues early and put you on the road to long-term health. Our yearly scan screens for potential cancers early, using AI to enhance the process, making it more efficient and affordable.