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Breast MRI: Techniques and Indications

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Breast Imaging

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

This chapter summarizes technical protocols and clinical indications for magnetic resonance imaging (MRI) of the breast. The established protocol used in the last two decades worldwide, essentially composed of an unenhanced T2-weighted sequence and a contrast-enhanced T1-weighted dynamic study, is firstly described. Thereafter, the new approaches allowed by diffusion-weighted imaging, currently integrated into routine clinical protocols, with a brief mention also of abbreviated contrast-enhanced protocols, are discussed. The following well-recognized indications for breast MRI are considered: screening of women at high risk for breast cancer; assessment of response to neoadjuvant therapy; search for occult primary breast cancer; and evaluation of implant integrity (with dedicated unenhanced sequences). Preoperative breast MRI is discussed describing the limitations of past studies and the new evidences regarding the cooperation between radiologists and surgeons to avoid unnecessary mastectomies and to tailor a conserving personalized treatment. The limited role of MRI in characterizing equivocal findings identified on mammography and/or ultrasound is also illustrated. In addition, the increasing role of MRI in the setting of nipple discharge and its potential for decision-making when lesions with uncertain malignant potential (B3) are found at mammography- or ultrasound-guided biopsy are outlined.

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Notes

  1. 1.

    We reported here the 95% confidence intervals due to their relevance for this topic.

Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

ACR:

American College of Radiology

ADC:

Apparent diffusion coefficient

AUC :

Area under the curve

BC:

Breast cancer

BI-RADS:

Breast Imaging Reporting and Data System

CE:

Contrast-enhanced

CI:

Confidence interval

DBT:

Digital breast tomosynthesis

DCIS:

Ductal carcinoma in situ

DWI:

Diffusion-weighted imaging

EBM:

Evidence-based medicine

EUSOBI:

European Society of Breast Imaging

EUSOMA:

European Society of Breast Cancer Specialists

Fat-sat:

Fat saturation

GBCA:

Gadolinium-based contrast agent

Gd:

Gadolinium

HER2:

Human epidermal growth factor receptor 2

MIP:

Maximum-intensity projection

MRI:

Magnetic resonance imaging

NAT:

Neoadjuvant therapy

NPV:

Negative predictive value

pCR:

Pathological complete response

PET:

Positron-emission tomography

PPV:

Positive predictive value

RCT:

Randomized controlled trial

RECIST:

Response evaluation criteria in solid tumors

ROI:

Region of interest

SPAIR:

Spectral attenuated inversion recovery

SPIR:

Spectral inversion recovery

STIR :

Short tau inversion recovery

US:

Ultrasound

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Authors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli & Rubina M. Trimboli

  2. Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy

    Francesco Sardanelli, Luca A. Carbonaro & Simone Schiaffino

Authors
  1. Francesco Sardanelli
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  2. Luca A. Carbonaro
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  3. Simone Schiaffino
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  4. Rubina M. Trimboli
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Corresponding author

Correspondence to Francesco Sardanelli .

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Editors and Affiliations

  1. Department of Radiology, Medical University of Graz, Graz, Austria

    Michael Fuchsjäger

  2. Department of Radiology, University of California, Davis (UCD) School of Medicine, Sacramento, CA, USA

    Elizabeth Morris

  3. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Thomas Helbich

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Sardanelli, F., Carbonaro, L.A., Schiaffino, S., Trimboli, R.M. (2022). Breast MRI: Techniques and Indications. In: Fuchsjäger, M., Morris, E., Helbich, T. (eds) Breast Imaging . Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-94918-1_9

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