Elsevier

Academic Radiology

Volume 15, Issue 4, April 2008, Pages 408-416
Academic Radiology

Radiology alliance for health services research
Breast MRI for Cancer Detection and Characterization: A Review of Evidence-Based Clinical Applications

https://doi.org/10.1016/j.acra.2007.11.006Get rights and content

Rationale and Objectives

Breast MRI is an important new tool in the imaging armamentarium for the detection and characterization of breast carcinoma. Understanding the evidence-supported benefits and potential harms of breast MRI is important to ensure the appropriate utilization of this medical resource.

Materials and Methods

This article reviews the clinical settings in which MRI for breast cancer assessment has been shown to be advantageous. The evidence regarding the diagnostic accuracy of MRI and the impact of this imaging tool on clinical outcomes are described. Novel breast MRI techniques which may lead to future improvements in performance are discussed.

Results

Breast MRI has been shown in multiple studies to be advantageous for screening patients at high risk, evaluating patients with a new breast cancer diagnosis, monitoring treatment response in patients undergoing neoadjuvant chemotherapy and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. Among the limitations of MRI are its high cost and modest specificity resulting in false positive examinations.

Conclusions

When used in evidence-supported clinical settings, the high sensitivity of MRI results in earlier cancer detection or greater accuracy of detection compared to existing tests for breast carcinoma. Further scientific endeavors are crucial to optimize the future performance and application of breast MRI.

Section snippets

Background

MRI of the breast was initially performed nearly 30 years ago as some of the earliest imaging of the body using this diagnostic technique (2). Subsequent investigation clarified the need for the use of contrast agents such as gadolinium to discriminate benign from malignant breast tissue and refined the techniques for obtaining consistent and high quality breast MRI. There is now broad agreement that breast MRI requires high temporal and spatial resolution, and that both morphologic and kinetic

Screening Patients at High Risk for Breast Cancer

Ten studies have evaluated the use of breast MRI for screening of women at high risk for breast cancer (3, 4, 5, 6, 7, 8, 9, 10, 11, 12). The patient populations have varied, but the majority of investigations included women at risk because of a known genetic mutation or those with a greater than 25% lifetime risk based primarily on family history. The results of these studies are summarized in Table 1. MRI consistently demonstrates higher sensitivity (reported range of 71%–100%) for detecting

Problem Solving for Clinical or Mammographic Findings

There are sparse data to support the use of breast MRI as a problem solving tool for challenging or equivocal mammographic findings. Similarly, there is a lack of evidence for breast MRI evaluation of suspicious clinical findings following a negative conventional workup with mammography and ultrasound. Bluemke et al studied the diagnostic accuracy of breast MRI in 821 patients with a suspicious mammographic finding (85%) or a suspicious clinical finding with a negative or benign conventional

Future of breast MRI

The field of breast MRI is rapidly advancing, and several new techniques hold promise for improving diagnostic accuracy and assessment of response to treatment.

Conclusions

Breast MRI has been demonstrated in multiple studies to be a valuable tool for the detection and characterization of breast carcinoma. Understanding the evidence-supported benefits and potential harms of breast MRI is important to ensure the appropriate utilization of this medical resource.

MRI of the breast has been shown to be advantageous when used for screening patients at high risk, evaluating patients with a new breast cancer diagnosis, monitoring treatment response in patients undergoing

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