Breast MR Imaging: Current Indications and Advanced Imaging Techniques

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Background

The formation of neovascularity by the malignant tumor serves as the basis for breast cancer detection by MR imaging. With the use of gadolinium-based intravenous contrast agents, the sensitivity of MR imaging for invasive breast cancer approaches 100%. The neovasculature of cancers does not resemble blood vessels found in normal tissue or benign lesions. These new blood vessels have increased permeability (ie, “leakiness”) resulting in rapid tumor uptake of contrast and early enhancement on MR

Basic MR techniques for breast cancer imaging

Since the early development of breast MR imaging, numerous technical developments, variations, and innovations have been described and often debated. Given the dynamic nature of MR imaging technology and the rapid pace of advances in hardware and software, any description of standard breast MR imaging techniques or protocols is by nature a reflection of the current state of the technology and the science as applied by breast imagers. This section describes the basic features of a breast MR

Breast MR Imaging at 3 T

With the advent of 3-T imaging, many investigators began to explore the options that breast imaging at this higher field would allow. At present, all major vendors provide breast coils for use at 3 T, many of which have features such as multicoil arrangements that are optimized for parallel imaging. In general, the signal of MR imaging increases by the square of the field strength, while the noise increases linearly with field strength. Thus, 3-T breast MR imaging in theory provides twice the

Local Cancer Staging

One of the most common uses for MR imaging is in the patient with recent diagnosis of breast cancer. MR imaging has the ability to map primary tumor size, define unsuspected additional foci of tumor, and to screen for clinically occult cancer in the contralateral breast. MR imaging can better estimate primary tumor size,85 allowing for appropriate surgical planning. MR imaging is also better able than mammography to depict primary tumor margins in invasive lobular cancers,86 and can lower

High-risk breast screening by MR imaging

Whereas the lifetime risk of breast cancer for a woman is as high as 1 in 8, for a woman who is a genetic mutation carrier the lifetime risk can be as high as 80%.148, 149 In addition to a significantly higher lifetime risk, these women tend to develop more aggressive cancers at an earlier age. Multiple studies have reported mammographically occult breast cancer detected by MR imaging in high-risk populations.3, 14, 15, 16, 17, 18, 19, 20, 21, 150 Therefore, surveillance by MR imaging, as an

Breast MR imaging controversies

Criticisms about MR imaging include the potential high false-positive rate, leading to unnecessary biopsies, and the clinical relevance of the MR imaging–detected secondary cancers. There are many factors that contribute to the false-positive rate. One is the interobserver variability of readers interpreting MR imaging studies,152, 153 a finding also observed in mammogram interpretations.154 It is hoped that as experience with breast MR imaging increases, the false-positive rate will decrease.

Summary

Breast MR imaging has brought about a revolution in breast imaging, and continues to evolve and improve technically. From its nascent period when the first contrast-enhanced MR imaging was performed, breast MR imaging use has grown substantially, with multiple clinical scenarios whereby MR imaging is now routine for screening, diagnosis, or staging of disease. There are still limitations to the technology; it is expensive and not as widely available as mammography. Deficiencies with specificity

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