Download Breast Cancer Detection and Diagnosis: Where does new

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
• Primary imaging modality in breast
imaging and early detection/diagnosis of
breast cancer
• Only imaging modality proven to reduce
mortality from breast cancer
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
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
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
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
Strengths (cont.)
• Uninfluenced by breast tissue density and
complexity of fibroglandular pattern
• Safe: no radiation
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
Sentinelle Table/Coil for
Breast MRI
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
• 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
42 year old presenting with a large, palpable mass
in the upper outer left breast:
Pre and post neoadjuvant chemotherapy
MRI-guided Breast Biopsy
• 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.
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.
• 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
Text Book
• David Sutton’s Radiology
• Clark’s Radiographic positioning and
techniques
Assignment
• Two students will be selected for
assignment.
Question
• Describe the Breast MRI Current
Indications?