Breast MRI
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Lenox Hill Radiology is pleased to offer state of the art services in breast MRI.
BENEFITS OF BREAST MRI
- Can image breast implants and ruptures
- Highly sensitive to small abnormalities
- Used effectively in dense breasts
- Can evaluate inverted nipples for evidence of cancer
- Can evaluate the extent of breast cancer
- Can help determine what type of surgery is indicated (lumpectomy or mastectomy)
- May detect breast cancer recurrences and residual tumors after lumpectomy
- Can locate primary tumor in women whose cancer has spread to axillary (armpit) lymph nodes
- Can spot or characterize small abnormalities missed by mammography
- May be useful in screening women at high risk for breast cancer, according to recent studies
MRI breast imaging has been approved by the U.S. Food and Drug Administration (FDA) since 1991 for use as a supplemental tool, in addition to mammography, to help diagnose breast cancer. Breast MRI is an excellent problem-solving technology. It is often used to investigate breast concerns first detected with mammography, physical exam, or other imaging exams. MRI is also excellent at imaging the augmented breast, including both the breast implant itself and the breast tissue surrounding the implant (abnormalities or signs of breast cancer can sometimes be obscured by the implant on a mammogram). MRI is also useful for staging breast cancer, determining the most appropriate treatment,and for patient follow-up after breast cancer treatment.
In addition to its role as a diagnostic tool, researchers have been investigating whether breast MRI may be useful in screening younger women at high risk of breast cancer. Most women under 40 years of age do not require any breast imaging. However, the American Cancer Society recently recommended that women at very high risk of developing breast cancer have annual breast MRI exams in addition to annual mammograms to increase the likelihood that breast cancer will be detected early, when the chances of survival are greatest. Because MRI is more sensitive than mammography, it can help detect cancer that may be missed by mammography. However, because this increased sensitivity can also lead to false positive results, which requires breast biopsy procedures, the American Cancer Society does not recommend MRI for all women.
How Breast MRI is Performed
Unlike mammography which uses low dose x-rays to image the breast, MRI uses powerful magnetic fields and radio waves to create images of the breast. The MRI system is able to switch magnetic fields and radio waves to achieve views in any plane and from any orientation while x-ray mammography requires re-orientation of the breast and mammography system for each view desired.
The main component of most MRI systems is a large tube-shaped or cylindrical magnet. To begin the MRI exam, the patient is positioned on a special table inside the MRI system opening where a magnetic field is created by the magnet. Each total MRI exam is typically comprised of a series of 2 to 6 sequences, with each sequence lasting between 2 and 15 minutes. An "MRI sequence" is an acquisition of data that yields a specific image orientation and a specific type of image appearance or "contrast."
During the examination, a radio signal is turned on and off, and subsequently, the energy which is absorbed by different atoms in the body is echoed or reflected back out of the body. These echoes are continuously measured by the MRI scanner. A digital computer reconstructs these echoes into images of the breast. A benefit of MRI is that it can easily acquire direct views of the breast in almost any orientation while mammography requires re-orientation of the breast and mammography system for each view desired. An MRI exam of the breasts typically takes between 30 and 60 minutes.
The most useful MRI technique for breast imaging uses a contrast material called Gadolinium DTPA, which is injected into a vein in the arm before or during the exam to improve the quality of the images. This contrast agent helps produce stronger and clearer images and "highlight" any abnormalities.
Benefits of an MRI Exam of the Breast
MRI has several potential benefits in helping to investigate breast concerns. An MRI exam allows breast images to be taken in any plane and from any orientation. One particular advantage of MRI is that it is highly sensitive to small abnormalities that can sometimes be missed with other exams. For instance, a mammogram or ultrasound (sonogram) of the breast may reveal breast cancer in one area. However, an MRI of the breast may show that the cancer is in fact multi-focal; small tumors are present in several areas of the breast. Researchers are currently investigating whether MRI would be helpful to routinely use on breast cancer patients to screen for cancer in the opposite breast. Determining the extent of breast cancer with MRI can help indicate treatment: breast conserving surgery (lumpectomy) or breast removal (mastectomy). Mastectomy is indicated if there are multiple tumors.
MRI may also be useful in helping to determine whether breast cancer has spread into the chest wall. If there is evidence of breast cancer in the chest wall, a patient often needs to undergo chemotherapy before breast cancer surgery. Not knowing whether the chest wall is involved can delay chemotherapy and cause the patient to have both chemotherapy and radiation therapy after surgery. Physicians sometimes use MRI to detect cancer recurrences in women who have already been treated for breast cancer with lumpectomy.
Another major benefit of MRI is that it plays a significant role in the visualization of breast implants. MRI can often show if an implant is leaking or ruptured. MRI can also image the breast tissue that is compressed by an implant. Implants can obscure some of the breast tissue on conventional mammogram images, making abnormalities or sings of cancer more difficult to see. This is because the x-rays used for mammography cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. MRI imaging does not have this limitation. However, mammography is still the best tool for evaluating breast tissue and for screening for breast cancer. There is currently no routine recommendation for using MRI as a cancer screening tool in women with implants, although it can be helpful in selected cases.
Because MRI is very sensitive, the American Cancer Society recently recommended that women at very high risk of developing breast cancer have annual breast MRI exams in addition to annual mammograms to increase the likelihood that breast cancer will be detected early. While most women under 40 years of age do not require any breast imaging (i.e., mammography), some younger women are at high risk of breast cancer due to a strong family history or a mutated breast cancer gene (BRCA1 or BRCA2). However, young women tend to have dense breast tissue which can make screening mammography less effective. This is because breast tissue density shows up as a white region on a mammogram just as a cancer would. (As women age, their breasts become less dense, increasing the effectiveness of screening mammography). With MRI, physicians may be able to more easily distinguish between density and breast abnormalities.
DYNACAD
Lenox Hill Radiology is equipped with a state-of-the-art Breast MRI CAD System, DynaCAD. Using DynaCAD, our Radiologists are equipped with a comprehensive set of computer-assisted detection (CAD) tools to perform real-time image analysis and interventional procedures with significantly increased diagnostic confidence.
