MR-Guided Breast Interventions: Pearls and Pitfalls, Part 1

Abstract and Introduction

Introduction

Dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI) has emerged as an important adjunctive modality, and the most sensitive modality available, to evaluate the breast for cancer screening, detection, diagnosis, staging, and treatment follow-up.^[1] DCE-MRI will find lesions that are mammographically and sonographically occult and lesions that are not clinically evident at physical examination. Despite its high sensitivity, DCE-MRI lacks the specificity to differentiate between benign and malignant lesions. For those lesions that are occult to conventional imaging modalities or physical exam and need to be further investigated, MR-guided breast interventions are essential.

With the mainstreaming of DCE-MRI, MR-guided breast interventions ought also to become broadly available. Current ACR Practice Guidelines for the Performance of MRI of the Breast (2008) state: "Facilities performing breast MRI should have the capacity to perform mammographic correlation, directed breast ultrasound, and MRI-guided interventions, or create a referral arrangement with a cooperating facility that could provide these services."^[2] Furthermore, the ACS Guidelines for Screening with Breast MRI as an Adjunct to Mammography state that breast MRI is "to be performed by experienced providers in facilities that provide MRI-guided biopsy for the follow up of any suspicious result."^[3] The procedure for performing MR-directed, vacuum-assisted core biopsy is described in detail.

Although several guidance techniques are available, we utilize the grid-localizing technique because of its simplicity and ease of use. Other localizing techniques are reported in the literature, including pillar and post, and free-hand techniques.^[4,5]

Cite this: Part 1: MR-guided Breast Interventions - Medscape - Mar 01, 2011.

Table 1. Summary of breast biopsy MR imaging protocol
Sagittal and axial localizer
Pre-contrast T1-weighted axial and sagittal with fat saturation	2-mm slice thickness
Post-contrast T1-weighted axial and sagittal with fat saturation	2-mmslice thickness 0.1mmol/kg @2 ml/sec start imaging after 30 seconds
Post- obturator placement images	2-mm slice thickness
Post- biopsy images	Sagittal and/or axial images, additional contrast administration may be necessary if lesion has washed out

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Part 1: MR-guided Breast Interventions

Pearls and Pitfalls

Abstract and Introduction

Introduction

Tables

References

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