Learning objectives
At the end of this educational exhibit the learner will:
1.
Become familiar with dynamic contrast enhanced breast MRI indications,
contraindications and protocol
2.
Recognize common artifacts and limitations caused by them
3.
Understand common pitfalls in breast MRI and how to recognize them
4. Discuss techniques and strategies for reducing or eliminating breast MR artifacts
Background
Breast MRI is an invaluable adjunct tool in breast imaging and the most sensitive imaging modality to detect breast cancer
Dynamic Contrast Enhanced Breast MRI is widely used withstandardized appropriate indications including: Preoperative planning in patients with new diagnosis of breast cancer; High risk screening; and additional evaluation when mammography and ultrasound results are inconclusive
MR images are susceptible to different types of artifacts
It is important to recognize these artifacts for appropriate and accurate image interpretation [1]
Findings and procedure details
(Figure 1)
Brief description of MRI indications and contraindications
Indications:
High risk screening – Begin at age 25 years old
Greater than or equal to 20% lifetime risk of breast cancer
BRCA 1,
BRCA 2,
CHEK2,
p53 mutations [2]
Other genes and syndromes (Li-Fraumeni,
Cowden syndrome,
etc.)
Strong family history of breast and ovarian cancer (more than one first degree relative with breast or ovarian cancer)
Chest mantle radiation in childhood
Intermediate risk screening
Moderately elevated risk of breast cancer (15%-20%)
Personal history of breast...
Conclusion
Dynamic contrast enhanced breast MR is the most sensitive breast imaging modality and widely accepted for high risk screening,
evaluation of patients with new diagnosis of breast cancer,
and for additional evaluation
Understanding of the imaging protocols,
techniques,
basic physics,
and potential limitations is imperative to maximize its utility.
References
Smith TB,
Nayak KS.
MRI artifacts and correction strategies.
Imaging Med.
(2010) 2(4): 445-457
Kriege M,
Brekelmans CT,
Boetes JC,
et al.
Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition.
N Engl J Med (2004) 351:427–437
Mann RM,
Kuhl CK,
Kinkel K et al.
Breast MRI: guidelines from the European society of breast imaging.
Eur Radiol (2008)18: 1307-1318
Liberman L,
Morris EA,
Dershaw DD,
Abramson AF,
Tan LK.
MR imaging of the ipsilateral breast in women...