What is a Breast MRI?
A breast MRI is a noninvasive test that utilizes a dedicated breast coil to evaluate the enhancement pattern of both breasts after the administration of gadolinium contrast. Special software is also utilized at our facility to assist in lesion enhancement characterization. Most breast cancers are vascular and enhance more than the background tissue.
What can the Patient Expect During the MRI?
The patient will fill out a questionnaire. IV access will be obtained. The patient will lay on their stomach with both breast positioned in the breast coil. Multiple images will be obtained at specific times to determine enhancement characterization of areas in the breast. The exam takes about 30-40 minutes to complete. It is important that women be imaged day 7-10 of their menstrual cycle to minimize the background enhancement of the breast.
What About MRI Guided Biopsy?
Breast MRI guided biopsy can also be performed for suspicious areas that are not well visualized on mammogram or by ultrasound. Many times a second look ultrasound or mammogram will be performed first.
Are Mammograms and Breast Ultrasound No Longer Needed?
Breast MRI can result in false positive results, so it is important to utilize other imaging techniques such as mammogram and ultrasound as well a physical exam. There are certain lesions that can be better characterized using mammogram and ultrasound. Many times, all of the modalities are needed.
What are indications for breast MRI?
ACR and ACS guidelines:
Screening: Women who meet at least one of the following conditions: (ACS screening guidelines)
- They have a BRCA1 or BRCA2 mutation
- They have a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves
- Their lifetime risk of breast cancer has been scored at >20% (based of risk assessment tools that look at family history and other factors)
- They had radiation to the chest between the ages of 10 and 30
- They have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes on a history in first-degree relative.
Most high risk screening women should begin getting annual breast MRI and mammograms at the age of 30, unless they and their doctor think it’s better to begin at a different age.
- Extent of disease in a new diagnosis of breast cancer and evaluate for the presence of multifocality and multicentricity
- Evaluate for invasion of the chest wall
- Presurgical planning
- Post lumpectomy with positive margins
- May be useful before, during, or after chemotherapy for response evaluation
- Contra lateral disease (opposite breast): MRI has been shown to detect occult malignancy in the opposite breast in at least 3-5%, and some studies up to 10% of the cases
- Recurrence of breast cancer or when clinical, mammographic, and/or ultrasound findings are inconclusive
- Evaluating scar tissue from recurrent cancer
- Metastatic cancer when the primary is unknown and suspected to be breast origin
- Lesion characterization when other examinations are inconclusive
Additional information that will be needed:
If a patient is being referred for breast MRI, it is important to have all of the previous mammograms, ultrasound, breast MRI imaging etc. and reports available for the radiologist to review at the time the breast MRI is performed. This is to enable the radiologist to make the most accurate interpretation. Otherwise, there may be a delay in the reading until all pertinent outside information is available.
Who interprets the results and how do I get them?
Breast MRI results are interpreted by a radiologist who is a physician trained to supervise and interpret radiological examinations. The radiologist will analyze all the images taken during your exam and send a signed report to the ordering physician this will take 24 to 48 hours, additional copies can be sent upon request to primary care physicians or specialists. The ordering physician or your primary care physician will go over the results with you.