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Topics in Magnetic Resonance Imaging - Current Issue

Topics in Magnetic Resonance Imaging - Current Issue
  1. DWI in the Assessment of Breast Lesions
    imageAbstract: Diffusion-weighted imaging (DWI) holds promise to address some of the shortcomings of routine clinical breast magnetic resonance imaging (MRI) and to expand the capabilities of imaging in breast cancer management. DWI reflects tissue microstructure, and provides unique information to aid in characterization of breast lesions. Potential benefits under investigation include improving diagnostic accuracy and guiding treatment decisions. As a result, DWI is increasingly being incorporated into breast MRI protocols and multicenter trials are underway to validate single-institution findings and to establish clinical guidelines. Advancements in DWI acquisition and modeling approaches are helping to improve image quality and extract additional biologic information from breast DWI scans, which may extend diagnostic and prognostic value.



  2. Abbreviated MRI and Accelerated MRI for Screening and Diagnosis of Breast Cancer
    imageAbstract: Although published studies have revealed that magnetic resonance imaging (MRI) is by far the most effective imaging modality for cancer detection, it is currently considered cost-ineffective for screening women at an intermediate risk for breast cancer. The concept of an “abbreviated MRI” protocol has recently emerged as a possible solution for reducing the cost of MRI. The abbreviated MRI is a shortened version of the standard MRI, consisting of a single early phase dynamic contrast enhanced (DCE) series. Several clinical studies have shown that this MRI protocol would not affect sensitivity or specificity for breast MRI screening purposes. In clinical practice, morphologic evaluation and kinetic assessment are 2 major components of the interpretation process. However, kinetic assessment cannot be performed with the abbreviated protocol, because multiple sets of post-contrast images are necessary for the generation of kinetic curves. “Accelerated MRI” is a collective term for imaging techniques that acquire DCE-MR images in a very short time. Published studies suggest that the kinetic assessment during the very early post-contrast phase obtained with the accelerated MRI techniques is comparable to that with the standard MRI techniques. Applying accelerated MR techniques could potentially enhance the abbreviated MRI protocol in terms of diagnostic potential, while maintaining the shorter study time. Thus, the abbreviated MRI protocol associated with accelerated MRI techniques may provide value for screening and for diagnostic purposes.



  3. Update on MRI of the Breast
    No abstract available



  4. MRI in the Assessment of BI-RADS® 4 lesions
    imageAbstract: The American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) lexicon, which is used ubiquitously to standardize reporting of breast magnetic resonance imaging (MRI), provides 7 BI-RADS assessment categories to indicate the level of suspicion of malignancy and guide further management. A BI-RADS category 4 assessment is assigned when an imaging abnormality does not fulfill the typical criteria for malignancy, but is suspicious enough to warrant a recommendation for biopsy. The BI-RADS category 4 assessment covers a wide range of probability of malignancy, from >2 to <95%. MRI is an essential noninvasive technique in breast imaging and the role of MRI in the assessment of ACR BI-RADS 4 lesions is manifold. In lesions classified as suspicious on imaging with mammography, digital breast tomosynthesis, and sonography, MRI can aid in the noninvasive differentiation of benign and malignant lesions and obviate unnecessary breast biopsies. When the suspicion of cancer is confirmed with MRI, concurrent staging of disease for treatment planning can be accomplished. This article will provide a comprehensive overview of the role of breast MRI in the assessment of ACR BI-RADS 4 lesions. In addition, we will discuss strategies to decrease false positives and avoid false negative results when reporting MRI of the breast.



  5. MRI for the Staging and Evaluation of Response to Therapy in Breast Cancer
    imageAbstract: Breast magnetic resonance imaging (MRI) is the most sensitive of the available imaging modalities to characterize breast cancer. Breast MRI has gained clinical acceptance for screening high-risk patients, but its role in the preoperative imaging of breast cancer patients remains controversial. This review focuses on the current indications for staging breast MRI, the evidence for and against the role of breast MRI in the preoperative staging workup, and the evaluation of treatment response of breast cancer patients.


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