WHAT IS BREAST MRI?

Breast MRI uses Magnetic Resonance Imaging (MRI) to look specifically at the breast. It is a non-invasive procedure that doctors can use to determine what the inside of the breast looks like without having to do surgery or flatten the breast (as in a mammogram).

Each exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by a Radiologist. No radioactivity is involved, and the technique is believed to have no health hazards in general.

The hope is that such non-invasive studies will contribute to our progress in learning how to predict the behavior of tumors, and in selecting proper treatments. Breast MRI is an evolving technology and should not replace standard screening and diagnostic procedures (clinical and self exams, mammogram, fine needle aspiration or biopsy).

WHAT SHOULD I EXPECT DURING THE EXAM?

The exam typically takes 30 to 45 minutes. First, patients must change into a hospital gown. Then, an IV is inserted into the arm. The patient will lie face down on a table, where the breasts are positioned into cup-like indentations on the table (breast coil). The table is then moved into the MRI machine.

The patient will need to lie very still as images are taken. About halfway through the exam, you will receive a painless injection and then more images are taken.

If you are claustrophobic or anxious about your MRI exam, don't worry. We can provide you with medication that will make you very comfortable during the exam. However, you will need someone to drive you home.

After the exam is complete, the images will be analyzed and interpreted by our Radiologists. Your results will not be available immediately following the exam. Your physician will be contacted with the results.

Please let us know if you are taking any hormones.

The breast MRI should be scheduled between day 5 and 15 of your menstruation cycle.

WHAT IS THE DIFFERENCE BETWEEN BREAST MRI AND MAMMOGRAPHY?

A mammogram is typically used as a first test for breast abnormalities. If a mammogram detects a problem, further specialized mammography and/or ultrasound may be used. If your doctor is still concerned, a Breast MRI is a diagnostic tool that may be considered. Breast MRI has been proven to potentially have value when other tests are inconclusive.

DO I STILL NEED TO HAVE A MAMMOGRAM IF I HAVE A BREAST MRI?

Absolutely. A Breast MRI should never take the place of your annual x-ray mammogram. Even if you have a normal Breast MRI, you should still continue to have an annual mammogram, one of the most effective tools in breast cancer detection.

WHAT IF I'M PREGNANT?

The decision to scan during pregnancy should be made on an individual basis. There is no known adverse effect of MRI on the fetus. The safety of gadolinium contrast has not been established for pregnant or nursing mothers. However, it is known that gadolinium-based MR contrast media crosses the human placenta and into the fetus when given in clinical dose ranges. Current data indicates that very little gadolinium is secreted in breast milk, with no known toxic effects on the infant. The supervising physician should take this into account, weighing potential risks and benefits, when counseling pregnant and lactating women referred for breast MRI.

Current Indications for Breast MRI:

Lesion characterization - Breast MRI may be indicated when other imaging examinations, such as ultrasound, mammography and physical examination are inconclusive for the presence of breast cancer.

• Local staging of breast cancer: In patients with biopsy- proven malignancy, breast MRI is used to determine extent of disease (multifocality and multicentricity) in the ipsi-lateral breast and to screen for disease in the asymptomatic contra-lateral breast.
• Neoadjuvant chemotherapy: MRI is used before and during the course of chemotherapy to evaluate chemotherapeutic response and extent of residual disease prior to surgical treatment.
• Post-lumpectomy bed evaluation/scar vs. recurrence: MRI is applied in patients with prior lumpectomy and questionable recurrence within the lumpectomy bed on mammography and ultrasound.
• Positive margins post lumpectomy: MRI is used to assess the extent of residual disease in patients with close or positive margins post-lumpectomy. MRI can help determine if re-excision or mastectomy will be necessary.
• Chest wall invasion: MRI is indicated for the evaluation of chest wall involvement prior to lumpectomy or mastectomy.
  
• Occult primary: In patients presenting with axillary lymphadenopathy and no mammographic evidence of malignancy, MRI is utilized to assess for an occult primary.
• Palpable lump: In patients with a palpable lump and a negative diagnostic evaluation on mammography and sonography, MRI may be useful to exclude an underlying abnormality.
• Problem-solving/difficult mammogram: MRI may be used as a problem-solving tool in the situation of a difficult mammogram.
• Screening of high-risk patients: Screening MRI is now recommended by the ACS for women with an approximate 20 percent to 25 percent or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women treated for Hodgkin's disease.
• Implant integrity: Non-contrasted MRI using silicone-sensitive sequences is used to assess implant integrity (intra- and extra-capsular implant rupture).

Learn more about our Advanced Breast Imaging services

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American Cancer Society Calls Announces New Recommendations Calling for MRI in Breast Cancer - new guidelines for MRI screening for breast cancer in high risk women. [download article]

	For detailed information, please visit the American College of Radiology website at www.acr.org
	Watch the Breast MRI WebCast
	Article "MRI best for familial breast cancer detection" - Reuters Health, 12/15/05