Medical Imaging Department, 12366University of Toronto, Ontario, Canada.
Breast Imaging Division, Joint Department of Medical Imaging, University of Health Network, Sinai Health and Women's College Hospital, Toronto, Ontario, Canada.
Can Assoc Radiol J. 2022 Feb;73(1):125-140. doi: 10.1177/08465371211030944. Epub 2021 Aug 12.
Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.
有几篇文献表明，在使用乳腺 X 线摄影术进行乳腺癌的检测和诊断的基础上，联合应用一些经济实惠的乳腺磁共振成像（MRI）技术，能起到有益的补充作用。在缩短标准乳腺 MRI 检查方案的时间时，有许多技术因素需要考虑，包括使用最佳的脂肪抑制、钆螯合物血管内对比剂进行动态成像，进行后处理减影和最大强度投影（MIP），以获得高空间和时间分辨率等。多项研究表明，包含钆依赖性技术（即动态对比增强 MRI，DCE-MRI）和非钆依赖性技术（即扩散加权成像/扩散张量磁共振成像，DWI/DTI）的多参数乳腺 MRI 技术，在检测乳腺癌方面具有极高的敏感性和特异性。本文综述了乳腺 MRI 的适应证，包括对高危人群进行乳腺癌筛查、评估化疗诱导的肿瘤反应、检测手术切除不完全后的残留肿瘤、检测腋窝淋巴结转移患者的隐匿性肿瘤、检测手术切除不完全的乳腺癌患者的残留肿瘤、检测常规成像结果模棱两可的患者的肿瘤，以及怀疑有乳房植入物破裂的患者。尽管乳腺 MRI 检测乳腺癌的敏感性最高，但也存在一些陷阱，如假阳性和假阴性的对比增强以及无对比增强 MRI 技术。了解不同方法的优缺点，以获得先进的乳腺磁共振成像图像，将有助于对有可疑乳腺病变的患者进行检查。
