Breast MRI: Full, Abbbreviate, and Ultrafast

Introduction

In this presentation, we will learn about abbreviated breast MRI and ultrafast MRI. We will start by presenting the full protocol, put things in perspective, review the basics of breast MRI techniques and protocols, and then learn about the abbreviated and ultrafast protocols. We will also give an overview of the indications for the appropriate use of breast MRI in context with the abbreviated protocol.

Objectives

  • Review the basics of breast MRI techniques and protocols.
  • Learn about the abbreviated MRI protocol.
  • Understand the ultrafast MRI protocol.
  • Discuss the indications for the appropriate use of breast MRI.

Full Breast MRI Protocol

Breast MRI is the most sensitive imaging modality to evaluate breast cancer and is not limited by density like mammography. The full protocol involves using a 1.5 Tesla magnet or higher, imaging both breasts simultaneously, and using a dedicated breast coil. The minimum sequences include T2 sequence, non-fat saturated T1 sequence, pre- and dynamic post-contrast sequences. The study is performed over a dynamic contrast-enhanced period with at least two or three post-contrast sequences.

Abbreviated Breast MRI Protocol

There is no strict definition for the abbreviated protocol, but it generally takes less than ten minutes. The first study discussing this was by Christiane Kuhn in Germany, suggesting a protocol that takes about three minutes. The abbreviated protocol has been shown to have similar sensitivity and specificity to the full protocol. The Akron EA 1141 study found that the abbreviated MRI had a significantly higher rate of invasive breast cancer detection compared to digital breast tomosynthesis.

Key Points

  • Shortened protocol under ten minutes.
  • Comparable sensitivity and specificity to the full protocol.
  • Effective for detecting invasive breast cancers.
  • Improved access and reduced cost.

Ultrafast Breast MRI Protocol

Ultrafast MRI is an imaging sequence that captures very fast initial inflow in the first two minutes with high spatial resolution. It measures time to enhancement, maximum slope, internal enhancement rate, and arterial-venous interval. Preliminary studies suggest it may improve diagnostic accuracy.

Key Points

  • Captures early enhancement with high temporal resolution.
  • Potential to improve diagnostic accuracy.
  • New terminologies: time to enhancement, maximum slope, internal enhancement rate, arterial-venous interval.

Indications for Breast MRI

The ACR has outlined practice parameters for the appropriate use of breast MRI in screening, extent of disease, and additional evaluation. High-risk patients, those with dense breasts, and those with known malignancies may benefit from breast MRI. The abbreviated protocol may be used for supplemental screening and other specific cases.

Key Points

  • High-risk screening starting at age 25.
  • Supplemental screening for dense breasts.
  • Evaluation of extent of disease and response to neoadjuvant chemotherapy.

Conclusion

We reviewed the full protocol for breast MRI, discussed the abbreviated MRI protocol, and explored the ultrafast MRI protocol. We also examined the indications for performing breast MRI and how both abbreviated and ultrafast protocols fit into these indications. The presentation highlighted the comparable sensitivity and specificity of the abbreviated protocol and the potential benefits of ultrafast MRI in clinical practice. Thank you for your attention.