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Breast MRI
Contrast Enhanced Dynamic Breast MRI
This is the latest, most advanced, and most exciting advance in breast imaging care in the past twenty years. Dynamic contrast enhanced Breast MRI offers women many advantages. Although this technique is relatively new, scientific studies in the past decade suggest that this method is more accurate than all other breast cancer detection methods. Scientific studies thus far indicate that it is more likely to find cancer when present and less likely to lead to a falsely positive exam compared to mammography. It requires no breast ionizing radiation (x-ray), requires no breast compression, and can depict the entire breast, even in women with breast implants.
What is the exact accuracy of Breast MRI?
The answer is not completely known, and clearly will ultimately vary depending on local professional expertise, technical quality, and the patient population that is studied. The preponderance of scientific literature, however, suggests an overall sensitivity of 90-98% and specificity as high as 93% (ranging from about 50-93%), figures that far exceed mammography, clinical exam, or any other known technique. It is important to note that studies thus far performed have been directed at women with breast cancer and/or high genetic risk. The accuracy of breast MRI in the general population is not established.
RMG and RSP introduced contrast enhanced MRI for breast cancer detection to San Diego County in January 1999 with the installation of San Diego's first high field strength, comfort-designed MRI, beginning at the RMG Encinitas Imaging Center. The procedure is now available also at the Mercy Magnetic Imaging Center, the RMG San Diego Imaging Center and San Clemente Imaging Center. Our clinical experience thus far is consistent with reports in the medical literature. We have found the exams to be extremely well tolerated by patients who appreciate the lack of breast compression and the ability to non-invasively investigate vital clinical problems. In the past six months, we have found clinically and mammographically occult lesions and also helped women avoid biopsies by classifying mammographically equivocal findings as benign. Examples include:
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A woman who presented with a cancerous axillary lymph node and no known primary malignancy. By finding the primary tumor, MRI enabled breast-conserving surgery. She underwent successful lumpectomy that removed the tumor found only on MRI, instead of the mastectomy that was otherwise required.
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A woman was evaluated due to a persistent lump, which was felt by MRI criteria to probably be an infected cyst, confirmed by clinical follow-up. The MRI however, also showed a clinically and mammographically occult cancer, which was subsequently excised and pathologically confirmed.
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A very deep lesion was seen on one view of a mammogram, but could not be localized because, despite multiple attempts, it could not be found on additional mammographic views. The lesion was confirmed with MRI, found to be extremely suspicious for malignancy, then localized using CT, surgically excised, and confirmed to be malignant.
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A women who had undergone prior lumpectomy and radiation therapy for breast cancer was found to have a local recurrence on MRI, leading to additional surgery that confirmed locally recurrent breast cancer.
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In many women, clinically and sonographically equivocal lesions not visible on mammograms were characterized as benign with MRI, thereby allowing biopsy to be avoided in favor of clinical follow-up.
Introducing Elective Breast MRI
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