MRI Breast Imaging: Clinical Practice Concerns

With the advancement of gradient strength, pulse sequences and coils, breast imaging has made huge inroads in tumor detection and specificity. MR breast imaging is pushing itself to forefront of advanced breast cancer diagnosis and treatment planning. Abundant clinical quality analysis and clinical trails have translated into rapid changes in approach to clinical breast care with improved interpretive skills from the radiologist. The technologist is an integral part to the equation. We, as technologists, need to understand the same mechanisms for acquiring diagnostic images. Have the ability to identify a lesion, selecting appropriate pulse sequences and to notify the radiologist of a finding. Doing all of this will result in better diagnosis and together this translates in to better treatment planning and hopefully, better patient outcome.

These are some of clinical indications of MR Breast are as follows and all have reasoning behind them.

• Implant Evaluation
• Axillary carcinoma of unknown origin
• Screening women at high risk
• Breast Cancer patients
• Ipsilateral extent of disease
• Contralateral breast screening for occult disease
• Post-surgical with positive close margins

Along with this are the minimal technical requirements which are listed below.

• 1.0 Tesla or higher field strength.
• Dedicated breast coil.
• High Spatial Resolution (1mm all planes)
• High Temporal resolution(Maximum five minutes).
• Slice Thickness (no greater than3mm).
• Fat and Chemical Suppression.
• All should be done bilaterally.

SITUATIONS THAT MAY AFFECT THE SCHEDULING BREAST MRI.

• Prior Mammogram - Must have prior mammograms (US films also if applicable)
• Pre-menopause - Must schedule between days 5-14 of the cycle
• Post menopause - If on hormone replacement therapy, must discontinue for at least 30 days prior to the MRI Birth Control Meds Notify the facility at the time of scheduling
• Breast Biopsy - May proceed with MRI breast exam after biopsy
• Lumpectomy - May be imaged right after but prior to any additional therapy
• Chemotherapy - Insurance may cover MRI breast prior and only after the therapy has been completed
• Radiation Therapy Patient must wait for 6 months after the completion of Radiation treatments (XRT)

With all of the advancements in technology, MR of the breast has its drawbacks in regards to the manual intervention from the technologist and the radiologist. Workflow suffers because of the number of sequences that need to be acquired and that the final data sets are very large. The length of the exams may tend to lead to patient motion which will cause artifacts and possibly false positives. Having said this, if your center/hospital is going to venture into breast MR, you will need to come up with unique scheduling, screening, standardized protocols, radiologists that can make a difference and the ability to make the patient comfortable.