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.
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.
Diagnostic:
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.
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