A type of smart MRI scan used in people with heart disease could help assess whether children’s cancers are especially aggressive and spot early signs that targeted treatments are working, a new study suggests. Researchers showed that the MRI imaging technique, known as T1-mapping, could offer crucial insights into the biology of childhood cancers and give an early warning of how effective targeted treatments were likely to be.

T1 mapping scans measure how water molecules interact at a microscopic level inside cells to understand the cellular make-up of tissue and are used in heart disease to assess damage to heart muscle tissue. Now, scientists at The Institute of Cancer Research (ICR), London, have shown that the noninvasive scanning technique has the potential to pick out children with high-risk forms of neuroblastoma, a type of childhood tumor.

The researchers believe T1 mapping scans could improve the use of precision medicine in children with neuroblastoma and potentially in cancer patients more widely, by ensuring treatments are tailored for each patient, and rapidly stopped when they are not working.

Researchers studied T1 mapping in mice with an aggressive form of neuroblastoma to get a clear picture of the microscopic and physical characteristics of the tumor. The team at The Institute of Cancer Research (ICR) used artificial intelligence to map the different cell populations in tumors and compared these maps with those created using non-invasive T1 mapping MRI scans.

The researchers found that regions with high T1 values—where water molecules can behave “more freely”—corresponded to hotspots of more aggressive cancer cells, which spread and grow faster. Meanwhile, areas with low T1 values corresponded to more benign or dead tissue, which is less harmful.

The researchers also looked at whether the imaging technique could help assess how mice with neuroblastoma would respond to two targeted drugs, alisertib and vistusertib, which target MYCN, a key protein linked to aggressive forms of the disease. They found that when alisertib and vistusertib successfully stopped the growth of tumors in mice, there was a decrease in T1 measures—reflecting the death of aggressive cancer cells.

The researchers believe aggressive cancer cells have high T1 values because they tend to be small but have large nuclei. By evaluating tumors’ cellular make-up with T1 MRI scans, clinicians would be able to get an accurate understanding of the stage and aggressiveness of the disease in children with neuroblastoma.

Next, researchers at the ICR plan to assess the clinical benefit of T1 mapping as part of a clinical study involving children. The new research is the first to assess the benefit of the MRI technique as a “smart” cancer biopsy—and researchers believe the results could be replicated more widely in other cancer types in children and adults.