Letter to the Editor: Evaluating Whole-Body MRI Screening on Its Own Merits

Amar P. Patel, MD¹; Karolina Brook, MD FASA CPPS²; Daniel J. Durand, MD MBA^3*

1. Vice President, Chief of Radiology, Prenuvo, Redwood City, CA

2. Vice President, Chief Quality Officer, Prenuvo, Redwood City, CA 

3. Chief Medical Officer, Prenuvo, Redwood City, CA 

* Corresponding Author

Corresponding Author:

Daniel Durand, MD MBA
2727 El Camino Real
Redwood City, CA 94061
Email: daniel.durand@prenuvo.com
Phone: 443-416-8431

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Davenport and Reeder raise timely concerns regarding whole-body MRI (WB-MRI) screening, including overdiagnosis, downstream testing, and the need for transparent consent.¹ However, because their analysis rests heavily on extrapolation from failed single-organ screening programs for ovarian and thyroid cancer, it systematically underestimates the benefits of WB-MRI and overstates its harms.

WB-MRI is not merely a cancer screening examination. It may identify clinically relevant nononcologic findings across multiple organ systems—such as hepatic steatosis, aneurysms, and uterine fibroids—which are collectively common, frequently underdiagnosed, and associated with significant population-level morbidity. Assessing WB-MRI solely as a cancer screening modality ignores the substantial pretest probability of actionable nononcologic findings, leaving their benefit uncounted.^2,3

The authors’ reliance on base-rate arguments from single-organ screening assumes a single, low pretest probability. In contrast, a multi-system examination spans findings with prior probabilities ranging from rare to near-ubiquitous in middle-aged adults. For instance, in a population-based cohort of 2,500 adults, potentially relevant incidental findings were identified in 36% of subjects, while malignancies accounted for fewer than 6% of findings.³ Therefore, the aggregate predictive value of WB-MRI cannot be inferred from baseline cancer risk alone. The follow-up rate reflects the cumulative yield of a multi-organ evaluation, not an excess of false positives.

While the authors frame these nononcologic findings as sources of downstream testing and potential harm, in our experience they are precisely what elective WB-MRI patients seek. To support patients ethically, our practice incorporates education, consent, post-scan review, and evidence-based follow-up recommendations.⁴

We respectfully disagree that the net harms of historical single-organ screening programs should be reflexively attributed to contemporary WB-MRI. Empirical evidence demonstrating physical, financial, or psychological harm in WB-MRI cohorts remains limited.⁵ Although the absence of evidence is not evidence of absence, it does not justify substituting speculative harms for empirical data.

The authors emphasize the absence of randomized mortality data supporting WB-MRI screening, while evidence demonstrating the long-term harms of contemporary WB-MRI programs also remains limited. We support thoughtful clinical adoption, transparent discussions with patients, and continued prospective study. Ultimately, evaluation frameworks must evolve beyond paradigms developed for traditional single-disease screening tests to better suit emerging multi-system preventive imaging technologies.

References

1. Davenport MS, Reeder SB. Elective MRI Screening of the General Public—Buyer Beware. JAMA. Published online May 6, 2026. doi:10.1001/jama.2026.5888.
2. Cieszanowski A, Maj E, Kulisiewicz P, et al. Non-contrast-enhanced whole-body magnetic resonance imaging in the general population: the incidence of abnormal findings in patients 50 years old and younger compared to older subjects. PLoS One. 2014 Sep 26;9(9):e107840. doi: 10.1371/journal.pone.0107840. 
3. Hegenscheid K, Seipel R, Schmidt CO, et al. Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management. Eur Radiol. 2013 Mar;23(3):816-26. doi: 10.1007/s00330-012-2636-6. Epub 2012 Aug 22. 
4. Petralia G, Koh DM, Attariwala R, et al. Oncologically Relevant Findings Reporting and Data System (ONCO-RADS): Guidelines for the Acquisition, Interpretation, and Reporting of Whole-Body MRI for Cancer Screening. Radiology. 2021;299(3):494-507. doi:10.1148/radiol.2021201740.
5. Korbmacher-Böttcher D, Bamberg F, Peters A, et al. Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study. Diagnostics (Basel). 2022;12(10):2356. doi:10.3390/diagnostics12102356.

Acknowledgements

We thank Vik Agarwal MD, Yosef Chodakiewitz MD, Alex Exuzides PhD, Tahreema Matin D.Phil MBBS and Lisa Sorger MBBS MHA for their critical review of the manuscript. 

Disclosures:

Dr. Patel reports being an employee of both Prenuvo, Inc and one of its exclusively affiliated professional corporations. He serves as Vice President and Chief of Radiology, and Chair of Prenuvo Medical Group. He holds stock options and/or equity in Prenuvo, Inc and receives a salary for his employment.

Dr. Brook reports being an employee of both Prenuvo, Inc and one of its exclusively affiliated professional corporations. She serves as Vice President and Chief Quality Officer. She holds stock options and/or equity in Prenuvo, Inc and receives a salary for her employment.

Dr. Durand reports being an employee of both Prenuvo, Inc and one of its exclusively affiliated professional corporations. He serves as Chief Medical Officer, and President of Prenuvo Medical Group. He holds stock options and/or equity in Prenuvo, Inc and receives a salary for his employment.