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MRI of the breast and emerging technologies

Author
Priscilla J Slanetz, MD, MPH, FACR
Section Editors
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Joann G Elmore, MD, MPH
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Magnetic resonance imaging (MRI) of the breast is an important tool for the detection of breast cancer (image 1 and image 2) and assessment of silicone implant integrity (image 3). The use of MRI with contrast agents for the detection of breast cancer was first reported in 1986 [1]. The high sensitivity of MRI for breast cancer has led to the increasing use of MRI for breast cancer detection, assessment, and treatment monitoring, although appropriate indications, scanning technique, and interpretation remain variable among facilities.

This topic will review breast MRI technique, interpretation, and indications as well as emerging tools for breast cancer detection. Issues regarding screening for breast cancer, the role of mammography and ultrasound in women with suspected disease, surveillance for patients with known breast cancer, and the physics of MRI are discussed separately. (See "Breast imaging for cancer screening: Mammography and ultrasonography" and "Screening for breast cancer: Strategies and recommendations" and "Clinical features, diagnosis, and staging of newly diagnosed breast cancer" and "Principles of magnetic resonance imaging" and "Approach to the patient following treatment for breast cancer", section on 'Breast MRI'.)

BREAST MRI TECHNIQUE

Magnetic resonance imaging (MRI) creates images of the breast by measuring changes in the movement of protons in fat and water with the application of changing magnetic fields. By utilizing the differences in tissue relaxation characteristics, an image is acquired by processing the signal changes that occur following application of pulses of energy. The physics of MRI is discussed in detail elsewhere. (See "Principles of magnetic resonance imaging", section on 'MR physics'.)

Breast MRI for the detection of breast cancer requires administration of the contrast agent gadolinium. The use of MRI for breast cancer detection is based on the concept of tumor angiogenesis or neovascularity. Tumor associated blood vessels have increased permeability, which leads to prompt take up and release of gadolinium within the first one to two minutes after administration, leading to a pattern of rapid enhancement and washout on MRI (figure 1). This dynamic rapid enhancement pattern helps to distinguish breast cancers from benign lesions. Breast MRI techniques continue to evolve, but some general recommendations can be made based on minimum standards used by the American College of Radiology Imaging Network (ACRIN) 6667 Trial [2] and the European Society of Breast Imaging [3].

Bilateral breast examination ─ Both breasts should be evaluated in an MRI study, for comparison purposes, even when concern about possible pathology involves only one breast.

                           

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