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Evolving Trends in Breast MRI

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. “Conventional” Breast Imaging:. Digital Mammography Breast ultrasound Breast MRI. Mammography.

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Evolving Trends in Breast MRI

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  1. Evolving Trends in Breast MRI Dr Mohamed El Safwany, MD.

  2. Intended learning outcome The student should learn at the end of this lecture evolving trends in breast imaging. .

  3. “Conventional” Breast Imaging: • Digital Mammography • Breast ultrasound • Breast MRI

  4. Mammography • Primary imaging modality in breast imaging and early detection/diagnosis of breast cancer • Only imaging modality proven to reduce mortality from breast cancer

  5. 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

  6. 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

  7. 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

  8. 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

  9. Strengths (cont.) • Uninfluenced by breast tissue density and complexity of fibroglandular pattern • Safe: no radiation

  10. 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

  11. Sentinelle Table/Coil forBreast MRI

  12. 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

  13. 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

  14. 42 year old presenting with a large, palpable mass in the upper outer left breast: Pre and post neoadjuvant chemotherapy

  15. MRI-guided Breast Biopsy

  16. 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.

  17. 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.

  18. 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

  19. Text Book David Sutton’s Radiology Clark’s Radiographic positioning and techniques

  20. Assignment Two students will be selected for assignment.

  21. Question Describe the Breast MRI Current Indications?

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