Evolving Trends in Breast MRI
Dr Mohamed El Safwany, MD.
Intended learning outcome
• The student should learn at the end of this lecture evolving trends in breast imaging.
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“Conventional” Breast Imaging:
• Digital Mammography
• Breast ultrasound
• Breast MRI
Mammography
• Primary imaging modality in breast imaging and early detection/diagnosis of breast cancer
• Only imaging modality proven to reduce mortality from breast cancer
Digital Mammography
• Major recent advance in mammography• Markedly improved contrast resolution• Studies have shown increase in breast cancer
detection: in women with dense breasts, pre/perimenopausal and age < 50
• Decreased mean glandular dose: 3.7 mGy vs 4.7 mGy
• Increased efficiency of acquisition, storage and post processing of images
Breast Ultrasound
• Invaluable adjunct to mammography• Advances in high frequency, 14 MHz
transducers with 3D format has led to improved resolution and increased utilization
• Easy to perform and well tolerated• Safe: No radiation• Characterization of lesions, evaluation of clinical
findings, guidance for biopsies, assessment of the axilla and screening high risk women with dense breasts
Magnetic Resonance Imaging (MRI) of the Breast
• Well established as imaging exam of choice in evaluation of silicone breast implants for rupture
• Rapidly evolved into a highly valuable/clinically useful adjunctive imaging exam for breast cancer detection/diagnosis/preoperative planning
MRI - Strengths
• Morphologic and physiologic assessment with high sensitivity: most malignant lesions enhance following administration of contrast due to tumor neoangiogenesis
• Cross-sectional; No overlap of structures
• Ability to include the breast, chest wall and axillary region
Strengths (cont.)
• Uninfluenced by breast tissue density and complexity of fibroglandular pattern
• Safe: no radiation
Recent Technical Advances Making MRI Feasible in Clinical Practice:
– Dedicated tables and surface coils allowing rapid, high-resolution, dynamic imaging of both breasts at the same time
– Robust fat suppression techniques– MRI-compatible power injectors– Dedicated computer soft ware programs for
soft copy display, review and data analysis with 3D MIPS, angiogenesis maps and time intensity curves
– MRI-guided biopsy techniques
Sentinelle Table/Coil forBreast MRI
Breast MRI: Current Indications
• Preoperative assessment of newly diagnosed breast cancers
• Adjunctive screening in high-risk women• Identify occult tumor in women presenting with
axillary metastases • Monitor response to neoadjuvant chemotherapy
in women with advanced primary tumors• Screening women with silicone injections• Evaluation of silicone gel implants for rupture
• MRI is not indicated for population-based screening
• MRI is not indicated for the evaluation of mammographic or sonographic suspicious findings that otherwise should be biopsied
42 year old presenting with a large, palpable mass in the upper outer left breast:
Pre and post neoadjuvant chemotherapy
MRI-guided Breast Biopsy
• Insufficient data to recommend for or against adjunctive MRI screening in high risk women based on personal history of breast cancer and/or atypical ductal hyperplasia or lobular neoplasia.
Future Advances in Breast MRI
• Breast MRI at 3T. Optimal breast imaging has not as yet been achieved or reported
• Breast MR Spectroscopy: dedicated coils and pulse sequences to determine choline and sodium levels which may be associated with malignancy.
• Mammography is the primary imaging modality in screening and diagnostic breast imaging
• Ultrasound invaluable and complimentary to mammography for lesion and clinical finding evaluation, guidance for biopsies, select screening
• Breast MRI plays important and increasing role in select settings: high-risk screening, preoperative assessment and occult malignancy detection
Text Book
• David Sutton’s Radiology
• Clark’s Radiographic positioning and techniques
Assignment
• Two students will be selected for assignment.
Question
• Describe the Breast MRI Current Indications?
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