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Breast MRI

Frequently Asked Questions Regarding Breast MRI

What is breast MRI?

Who is a candidate for breast MRI?

How is the procedure done?

Why is an IV necessary?

Is breast MRI a better test than mammography?

Can I just have MRI instead of a mammogram each year?

Are there any drawbacks to breast MRI?

Will I have to go into the "tunnel" to have the MRI?

How long does a breast MRI take?

If the MRI is positive does that mean I have breast cancer?

If the radiologist sees something on the breast MRI what will happen?

What is MRI of the Breast?

What are some common uses of the procedure?

How should I prepare for the procedure?

What does the MRI equipment look like?

How does the procedure work?

How is the procedure performed?

What will I experience during the procedure?

Who interprets the results and how do I get them?

What are the benefits vs. risks?

What are the limitations of MRI of the Breast?

What is the difference between Breast MRI and Mammography?

Is there a disadvantage to breast MRI?

Is a dedicated breast coil used?

Can I have Breast MRI if I have implants?

What is the difference between a breast tissue evaluation with implants and an implant evaluation?


What is breast MRI?

Breast MRI is a highly sensitive noninvasive test which examines the inside of the breast through hundreds of images. There is no compression or flattening of the breast during this exam and there is no radiation exposure.

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Who is a candidate for breast MRI?

Most patients getting a breast MRI fall into three categories:

1. Patients with newly diagnosed breast cancer

In patients with newly diagnosed breast cancer, breast MRI can be quite helpful in determining the exact tumor size and extent which can allow for much more accurate surgical planning. Sometimes there is an unsuspected second cancer or the tumor proves to be larger than originally thought in as many as 10% of the cases, which can drastically change the surgical approach and outcome.

2. Patients with a diagnostic problem that cannot be answered with mammography and breast ultrasound.

An example of a diagnostic problem includes a breast lump that is suspicious on physical exam, but not detected by conventional imaging with mammography or ultrasound. Another common diagnostic problem is an ultrasound or mammographic finding for which the radiologist recommends further evaluation.

3. Patients who are suspected to have a breast implant rupture.

MRI is the most accurate test to determine the integrity of a breast implant.

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How is the procedure done?

The patient lies face down on a special breast MRI table which allows her breasts to hang through an opening which will allow the MRI to provide very detailed images of each breast. A simple IV line is established beforehand to allow injection of a type of contrast which will help the radiologist determine whether there is an area in the breast which is suspicious for cancer. The patient must be able to lie still, and the exam takes approximately 30 minutes.

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Why is an IV necessary?

The IV is needed to give a special type of MRI contrast called gadolinium. Breast cancers typically have a rich blood supply, so tumors "light up" on MRI. It is this contrast that makes MRI more sensitive in cancer detection than mammography. Allergies to this type of dye (which is different than "x-ray dye") are extremely rare.

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Is breast MRI a better test than mammography?

The two tests are both great exams, each with their own strengths. Most commonly, breast MRI is performed to answer a specific question raised from the patient's mammogram. Breast MRI is a more sensitive test in detecting breast cancer than mammography. There are some cancers that can be seen with MRI that cannot be seen with mammography. This is especially true in patients who have dense breast tissue. Regardless of breast density, if a breast cancer is present, breast MRI can detect it greater than 95% of the time, while mammography can detect cancer approximately 80-90% of the time. If the patient has dense breast tissue, the rate of detection of cancer can go down to as low as 50% by mammogram alone. For this reason, breast MRI can be quite helpful in this sub-group of patients who have dense breast tissue on their mammograms and a change in their mammogram, a palpable lump or a biopsy-proven cancer.

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If MRI is a more sensitive test than mammography, can I just have this test instead of a mammogram each year?

No. All breast MRI's should be read in conjunction with the patient's mammogram. Both mammography and MRI have different strengths. For example, mammography is better at detecting very tiny calcifications, which can be an early sign of breast cancer.

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Are there any drawbacks to breast MRI?

Cost. The procedure is expensive. While most insurers will cover a large proportion of the cost for appropriate diagnostic uses, most insurers will not cover the cost for screening when there are no symptoms. In addition, since it is such a very sensitive study, there will be higher "false positive" findings than with mammography, and these false positives may require follow-up MRI or a needle biopsy. This is why it's essential for highly qualified breast imaging specialists to evaluate the patient's prior mammograms and ultrasounds to assure that breast MRI is medically necessary for each patient.

A breast MRI is a non-x-ray study using magnetic energy that images both breasts at the same time. It is a technology that requires the administration of a non-iodine contrast material intravenously to show areas in the breast that have an active growth pattern.

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Will I have to go into the "tunnel" to have the MRI?

Yes, the breast must be in the center of the magnet, but unlike most body scanners you will be on your stomach, and go into the magnet feet first. Most women who have had other types of MRI's find the dedicated breast MRI does not give the claustrophobic feeling that often accompanies other MRI's.

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How long does a breast MRI take?

The entire study takes approximately 45 minutes. You will first have a series of images done. Then you will be given the contrast injection and the images will be repeated. The radiologist will then compare the images without contrast to the images with contrast.

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If the MRI is positive does that mean I have breast cancer?

No. There are many benign conditions that will be seen on a breast MRI. The most common are some cysts, fibroadenomas, and papillomas.

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If the radiologist sees something on the breast MRI what will happen?

If an abnormality is seen, the radiologist will characterize it as one that needs only a follow up MRI study in three to six months or as an abnormality that requires a biopsy. Needing a biopsy does not mean you have breast cancer.

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What is MRI of the Breast?

Magnetic resonance imaging (MRI) is a non-invasive way of viewing organs, soft tissues, bone and other internal body structures without the use of x-rays. MRI uses a magnetic field and radio waves together with a computer to create cross-sectional, three-dimensional pictures of the head and body. Detailed MR images allow physicians to better evaluate parts of the body for conditions that may not be visible with other imaging methods (such as x-ray, ultrasound, or computed tomography (CT) scan). MRI has proven very valuable in diagnosing a broad range of conditions, including cancer, heart and vascular disease, stroke and musculoskeletal disorders.

MRI of the breast is not a replacement for mammography or ultrasound imaging but rather is a supplemental tool for detecting and staging breast cancer and other breast abnormalities.

Medical studies are currently being conducted to determine whether MRI and other imaging methods can contribute to the early detection of, and prevention of deaths from, breast cancer. Recent research has demonstrated that MRI can detect some small breast lesions sometimes missed by mammography. MRI can also help detect breast cancer in women with breast implants and younger women with dense breast tissue--both of which are difficult to image using traditional mammography. Because MR imaging does not involve radiation, the procedure could be used to screen women younger than 40 and to increase the number of screenings per year for women at high risk for breast cancer.

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What are some common uses of the procedure?

MRI is used to:

  • evaluate abnormalities detected by mammography.
  • identify early breast cancer not detected through other means, especially in women with dense breast tissue and those at high risk for the disease.
  • screen for cancer in women who have implants or scar tissue that might jeopardize an accurate result from a mammogram.
  • determine the integrity of breast implants.
  • distinguish between scar tissue and recurrent tumors.
  • assess multiple tumor locations.
  • check the progress of chemotherapy.
  • look for multiple tumors prior to breast conservation surgery.
  • determine whether cancer detected by mammography or ultrasound has spread further in the breast or into the chest wall.
  • determine how much cancer has spread beyond the surgical site after a breast biopsy or lumpectomy.
  • provide additional information on a diseased breast to make treatment decisions.

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How should I prepare for the procedure?

You may be asked to provide a urine sample for a pregnancy test prior to your MRI exam. Because the risks to a fetus are unknown, pregnant women should not have an MRI exam unless the potential benefit from the MRI is determined to outweigh the potential risks.

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What does the MRI equipment look like?

The traditional MRI unit is a large, cylindrical-shaped magnet. The patient lies on a moveable bed that slides into the magnet where the imaging is performed. For an MRI of the breast, the patient lies face down on her stomach with her breasts hanging freely into cushioned openings, which are surrounded by a breast coil. The breast coil is a signal receiver that works with the MRI unit to create the images.

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How does the procedure work?

Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not depend on radiation. Instead, radio waves are directed at protons, the nuclei of hydrogen atoms, in a strong magnetic field.

The magnetic field is produced by passing an electric current through wire coils in the MRI unit. Other coils, such as the breast coils placed around each breast, send and receive radio waves. As you lie in the MRI machine, radio waves are directed at the protons in your body. In the magnetic field, protons change their position, producing signals that are detected by coils within the MRI unit.

A computer processes these signals and generates a three-dimensional representation of your body. Each image shows a thin horizontal slice of the breast tissue. A computer compiles the images, which can be studied from many different angles on a video monitor for evaluation. MRI scans produce hundreds of images that the radiologist reads and interprets.

MRI helps identify tumors by highlighting the differences in water content and blood flow between tissues. Because malignant breast tumors grow their own blood supply network, they tend to be surrounded by more blood vessels than other tissue nearby. As a result, when contrast material is injected into the bloodstream, a tumor "lights up" on an MRI scan.

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How is the procedure performed?

If your physician is using a contrast material during your MRI exam, a nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm. You will be positioned face down on the moveable bed with your breasts hanging into the cushioned openings. The bed will then be moved into the magnet of the MRI unit.

The radiologist and technologist will leave the room while the MRI examination is performed. You will be asked to lie still while the machine acquires the images. Imaging is done in sequences, each lasting between one and fifteen minutes. In between sequences, you will be able to relax. You will know when images are being recorded because you will hear tapping or thumping sounds when the coils that create the magnetic field are turned on.

After an initial series of scans, the contrast material is injected into the intravenous line. Additional series of images are taken following the injection. When your exam is completed, you will wait a short time on the table while the images are evaluated to ensure no additional images are needed. Your intravenous line will be removed.

The imaging session lasts between 30 minutes and one hour and the total exam will take approximately an hour and a half.

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What will I experience during the procedure?

MRI of the breast is a pain-free procedure. Your breasts may feel slightly warm, but this is normal and harmless. If contrast material is needed, there may be discomfort at the injection site, and you may have a cool sensation at the site during the injection. Some patients can find it uncomfortable to remain still during MR imaging.

When it is inserted, the intravenous needle may cause you some discomfort; once it is removed, you may experience some bruising. There is also a very small chance of irritation or infection. When the contrast agent is injected, it is normal to feel coolness throughout your body.

During your exam, you will be able to talk to the radiologist and technologist, who will observe you from an adjacent room throughout the exam. You may request earplugs to reduce the noise of the MRI scanner, which produces loud thumping and humming noises during imaging. Some scanners have music to help pass the time. MRI scanners are air-conditioned and well lit. Many MRI centers allow a relative or friend to stay close by during your exam.

Following your MRI, no recovery period will be necessary. You may resume your usual activities and normal diet immediately after the exam. A few patients experience side effects from the contrast material, including nausea and local pain. Very rarely, patients are allergic to the contrast medium and experience hives and itchy eyes.

It is recommended that nursing mothers not breastfeed for 36 to 48 hours after an MRI with a contrast material.

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Who interprets the results and how do I get them?

A radiologist, a physician experienced in MRI and other radiology examinations, will analyze the images and provide a report to your primary care or referring physician. You will most often receive your results from your primary care physician and/or by the physician who requested the exam be performed.

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What are the benefits vs. risks?

Benefits

MRI has been shown to detect small breast lesions that are sometimes missed by mammography. MRI can successfully image the dense breast common in younger women, as well as breast implants. MRI contrast material is less likely to produce an allergic reaction than the iodine-based materials used for conventional x-rays and CT scanning.

MRI is a non-invasive imaging technique that does not require exposure to radiation. MRI provides more clear and detailed images of the soft-tissue structures of the body than other imaging methods. The detail makes MRI an invaluable tool in early diagnosis and evaluation of tumors.

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Risks

The MRI examination poses no risk to the average patient when appropriate safety guidelines are followed. An undetected metal implant may be affected by the strong magnetic field. There is a very slight risk of an allergic reaction if contrast material is injected. Such reactions usually are mild and easily controlled by medication. There also is a very small risk of skin infection at the site of injection. If sedation is used, there are risks of excessive sedation. The technologist monitors the patient's vital signs to minimize this risk.

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What are the limitations of MRI of the Breast?

MRI of the breast cannot always distinguish between cancer and benign breast disease (such as fibroadenomas), leading to a false positive result. A false positive is a result that indicates cancer when there is in fact no cancer present.

Breast MRI uses Magnetic Resonance Imaging (MRI) to look specifically at the breast. It is a non-invasive procedure that doctors can use to determine what the inside of the breast looks like without having to do surgery or flatten the breast (as in a mammogram). Each exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by a Radiologist. No radioactivity is involved, and the technique is believed to have no health hazards in general.

The recent interest in MRI of the breast follows reports that malignant (or cancerous) lesions get brighter following a contrast agent injection. MRI has been shown to detect small breast lesions that are sometimes missed by mammography, and MRI can successfully image the dense breast (usually found in younger women) and breast implants. However, contrast MRI sometimes has a hard time distinguishing between carcinoma and benign breast disease. Some benign breast tissues (such as fibroadenomas) can also get bright after contrast injection, which can cause a false positive result. Research is currently going on at multiple institutions to improve breast MRI.

For MRI of the breast, the patient lies on her stomach with both breasts hanging freely into a cushioned recess containing the signal receiver (also known as the breast coil). The entire bed on which she is lying is advanced into the opening of the magnet (a tube-like machine that looks like a giant donut--open at both ends). The subject will be asked to lie still for up to 15 minutes at a time while the computer acquires the images; the total examination is made up of several scans, usually 5 to 15 minutes in length and the patient is usually in the magnet for 40-60 minutes.

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What is the difference between Breast MRI and Mammography?

Normal mammograms use x-rays to generate images of the breast tissue to search for cancer. MRI, on the other hand, uses no x-rays. The ability to identify a mass in the breast requires that the mass has a different appearance (or a different contrast) from normal tissue. With MRI, the contrast between soft tissues in the breast is 10 to 100 times greater than that obtained with x-rays. This is why MRI is used much more than, for example, CT (or CAT) scanning, which uses x-rays, for diagnosing tumors in the brain. As opposed to x-rays, which are known to cause damage to DNA of cells, the magnetic fields and radiowaves used with MRI are not known to have any long term biologic effect. MRI of the breast does require intravenous injection of a 'contrast agent,' which helps highlight breast abnormalities.

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Is there a disadvantage to breast MRI?

Another disadvantage of breast MRI is it doesn't detect certain types of very small calcifications, which on a mammogram can be an early indication of cancer. Instead, breast MRI uses different cancer markers, including the blood flow of the tumor, as well as the size and appearance of the tumor.

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Is a dedicated breast coil used?

Body parts need to be imaged by a specific coil to get the best pictures possible. For example, a head MRI requires the head to be surrounded by a head coil. You can image the breast using a general body coil, however, the images will be much better when dedicated breast coil is used. Therefore, it is in your best interest to only do a breast MRI exam if a dedicated breast coil is used.

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Can I have Breast MRI if I have implants?

Absolutely. MRI is a useful tool for women who have breast implants since an exam using a contrast agent can help distinguish between the implant, scar tissue, normal and other breast tissues. The pictures from MRI are of the free-hanging breast and are three-dimensional (versus a mammogram, which compresses the breast and only gives a two-dimensional picture).

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What is the difference between a breast tissue evaluation with implants and an implant evaluation?

A breast tissue evaluation with implants is concerned with the breast tissue surrounding the implant, whether or not there is cancer. This type of exam requires a contrast agent. An implant evaluation, on the other hand, is just concerned with the implants, for example, if they are leaking or have ruptured. A contrast agent is usually not used in such exams and will therefore provide no information about the possibility of disease in the breast tissue itself.

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