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Magnetic resonance imaging (MRI) is a noninvasive technology to assist your doctor in diagnosing and treating conditions that affect your health. Many people do not realize that MRI does not use radiation such as X-ray but uses powerful magnetic fields and radio waves that are interpreted by a computer. The computer produces very detailed pictures of organs, bone, and soft tissues of the body.

MRI of the breast is not a replacement for a mammogram or breast ultrasound but is an added help to diagnose breast conditions including breast cancer. Breast MRI has been approved by the FDA since 1991 as a supplemental tool to mammography and was approved to assist in the diagnosis of breast cancer.

How is breast MRI performed?

The MRI unit is able to switch between radio waves and magnetic fields to build an image in any plane or orientation with moving equipment or the patient. The patient is positioned on the table of the MRI unit where a magnetic field is created by the large tube shaped magnet. The best results of MRI for the breast are created by injecting a contrast medium called gadolinium into a vein in the arm before or during the procedure. The contrast helps produce clearer and stronger images and will accentuate any area of concern. The study usually takes 30-60 minutes to complete a study of the breast. During the study, a radio signal is switched on and off and the energy is reflected back out of the tissues at different wave lengths. A computer takes the data and constructs the echoes reflected back into images of the breast.

Who is a candidate for MRI of the breast?

Anyone could be a candidate for breast MRI but the study is not appropriate for all individuals. MRI of the breast is usually done for the following indications:

• To evaluate abnormalities that were discovered by breast ultrasound or mammogram
• To assist in detecting breast cancer in patient at high risk for breast cancer such as women with extremely dense breast or have a high suspect
• To screen women with implants or scar tissue that might decrease that ability of the mammogram detection of abnormalities
• To help distinguish between abnormalities and scar tissue
• To check on the intactness of breast implants
• To evaluate tumor locations and look for multiple tumors in the breast prior to conservative surgery
• To determine whether a cancer has spread in the breast or into the chest wall
• To evaluate effectiveness of therapy for breast cancer.
• To determine whether there is more cancer in the breast beyond the site of a breast biopsy or lumpectomy
• To provide to the physician information about the diseased breast for making proper decisions for therapy

By comparing breast images from mammogram or ultrasound to the MRI information can be obtained to determine if there are abnormalities present, whether an abnormality is benign or malignant, if lymph nodes are enlarged, and the size and location of an abnormality.

Recently the American Cancer Society has developed recommendations that a woman with one of the following situations should have a breast MRI:

• A BRCA1 (breast cancer gene) or BRCA2 mutation present
• A first degree relative (parent, sibling or child) with BRCA mutation,
• A history of radiation to the chest between ages of 10 and 30

What are the limitations of breast MRI?

Although breast MRI offers an aid for diagnosis to mammography and ultrasound, there are limitations with MRI.

• MRI can not always distinguish between malignant and benign lesions
• It can not effectively show calcifications in the breast which can be seen on mammograms. These calcifications are sometimes associated with certain types of breast cancer.
• MRI may produce false-positive tests that may appear to be a suspicious lesion in the breast. This may lead to unnecessary biopsies and anxiety.
• MRI is an expensive test ranging from $1000-1500
• Patients with claustrophobia may have difficulty being within the magnetic tube.
• It takes 30-60 minutes compared to 10 minutes for a mammogram
• It requires the use of a contrast medium

What should be done to prepare for the study?

• Wear loose fitted clothing with no metal fasteners
• The MRI center should know about medical conditions and medications that you are using
• If you have anxiety or claustrophobia you may want to request a sedative prior to the procedure
• Jewelry, watches, credit cards, hearing aids can be damaged by the magnetic field
• Pins, hairpins, zippers, or other metallic objects can distort the MRI images
• Removal dental works should be removed
• Pens, pocketknives and eyeglasses are not allowed in the unit
• MRI is safe for patient with metal implants except for patients with internal defibrillators, cochlear implants, and clips used on brain aneurysms
• Electronic devices in the body such as artificial heart valves, implanted drug infusion ports, pacemakers, and implanted nerve stimulators may interfere with the exam
• Shrapnel in the body may require an X-ray prior to doing the MRI
• Dyes used in tattoos may contain iron that may heat up during the MRI

Again it must be stated that breast MRI is not an alternative to a mammogram but is an additional test available to gather information that may assist in the care of a patient. It is an aid in choosing proper therapy options for the individual. Questions have been raised about whether only the breast of concern or both breasts should be studied by the MRI. Most experts in the area feel that it is best to study both breast to be able to compare the images of both breast to each other. Body parts need to be imaged by equipment that is specific for that body part to obtain the best study possible. MRI units with dedicated breast coils give the most accurate images not a unit that is used for generalized body study. The study should be discussed with your physician so that you have the best information and a proper decision whether the study is needed can be made.