A Closer Look at Breast MRI

If you have recently been diagnosed with breast cancer, it’s normal to feel worried, confused, angry, or sad. It’s important to take your time and process these emotions at your own pace. At this stage, your doctor may be taking steps to stage the cancer to determine a suitable treatment plan for you. This may include a breast MRI scan. Having a general understanding of what a breast MRI scan is, how it works, its potential side effects, and what to expect during the scan may help prepare you and reduce some mental anxiety.

Magnetic resonance imaging (MRI) is an advanced medical imaging technology that offers a non-invasive and highly detailed look at various body tissues and organs. The technology uses powerful magnets to generate a strong magnetic field and computer-generated radio waves to produce three-dimensional images.

These images are created based on the chemical nature of molecules and the magnetic properties of different tissue types. In some cases, contrast agents containing the element Gadolinium are administered intravenously to increase the brightness of the image during or before the MRI procedure. This further increases the clarity and accuracy of the images produced by the MRI machine.

The detection of breast cancer is a crucial aspect of one’s health, requiring the use of advanced imaging technologies. MRI stands out as a reliable option due to its high sensitivity rate of 90%. However, MRI cannot completely replace other imaging technologies, as certain limitations and higher costs are still associated with its use. Nonetheless, the benefits of MRI technology make it an essential tool for early detection and treatment planning in breast cancer patients.

Breast MRIs can be quite costly when compared to other imaging tests like mammograms and ultrasounds. As such, they may be recommended for more urgent cases. The European Society of Breast Imaging (EUSOBI) recommends breast MRIs for certain individuals, including:

• Screening for women with a high risk of breast cancer

MRI is a highly sensitive screening tool, particularly useful for those at higher risk of developing breast cancer.

• Preoperative staging of newly diagnosed breast cancer

When relying solely on mammography and ultrasound, there is a risk of significantly underestimating or overestimating the size of a tumor. MRI is the most reliable imaging technique for measuring tumor size, although it may sometimes overestimate the size of pure DCIS lesions.

• Evaluation of response to neoadjuvant chemotherapy

MRI is superior to evaluating tumor response to neoadjuvant chemotherapy compared to clinical examination mammography or ultrasound.

• Evaluation of Females with breast implants

MRI can determine whether suspicious features are due to breast implant ruptures or not, especially if mammograms and ultrasounds are inconclusive.

• Detection of occult primary breast carcinoma

Occult primary breast cancer is a rare form (up to 1%) of breast cancer. It occurs when metastases are detected with a breast origin, but no primary breast tumor can be detected, even if mammography and ultrasound results are negative. MRI can identify the primary breast cancer in about two-thirds of such cases, allowing for less extreme treatment measures, if possible.

• Confirming suspected local recurrence when needle biopsy cannot be performed

In some cases where a needle biopsy cannot be performed (e.g. if the breast skin is too thin), a breast MRI may be used.

• Problem-solving (when mammography and ultrasound give ambiguous results)

When mammogram and ultrasound results are inconclusive, MRI is often used for breast cancer detection due to its higher sensitivity. However, it is seldom recommended as the first diagnostic imaging method due to its higher costs.

MRI imaging does not involve radiation exposure like mammography with x-rays. However, there are still potential risks associated with MRI that one should be aware of.

• It may not be suitable for those with severe claustrophobia. Psychological preparation or sedation may be needed before undergoing the procedure. This is because it involves being confined in a narrow tube for up to 30 minutes.
• Due to strong magnetic fields and radiofrequency waves, it cannot be used for those with non-MRI-compatible intracranial ferromagnetic clips for aneurysms and iron splinters in the eyes.
• It is unsuitable for patients with implantable electronic devices such as certain pacemakers and cardioverter defibrillators.
• Certain tattoos or permanent make-up may have iron pigments that may heat up and cause local burns during an MRI.
• Some may have allergic reactions to contrast agents.
• Those with very poor kidney functions risk suffering from nephrogenic systemic fibrosis after injection of the contrast agent.
• While MRI has a high sensitivity in detecting cancer, it also has a very high sensitivity for detecting benign breast conditions, which may lead to additional burdens such as further tests and biopsies.

Breast MRI results are reported the same way as mammograms using the Breast Imaging Reporting and Data System (BI-RADS). It is a categorized system that standardizes how doctors and radiologists describe and interpret breast imaging results.

Learn More: Understanding Your Mammogram Report

It is normal to experience apprehension when faced with the prospect of undergoing an MRI scan, especially if it is your first time. However, it is good to remember that this procedure is entirely painless and quick, and it will significantly contribute to your overall treatment plan. While the experience may feel unfamiliar, rest assured that you will be in safe hands throughout the entire process.