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Line 1: {{Short description\|Form of breast imaging}} ~~{{Interventions infobox \|~~ {{Infobox interventions\| ~~Name = {{PAGENAME}} \|~~ ~~Image~~ Name =Breast MRI\| ~~Caption~~Image =Mri of breast cancer.jpg\| Caption =Breast MRI demonstrating marked enhancement (bright area) which was confirmed to be cancer.\| ~~ICD10 = BH3 \|~~ ~~ICD9~~ICD10 =BH3\| ICD9 = ={{ICD9proc\|88.92}}, {{ICD9proc\|88.97}} \| MeshID = \| OPS301 = {{OPS301\|3-827}} \| OtherCodes = \| }} One alternative to [[mammography]], '''~~Breast~~breast MRI ''' or contrast -enhanced [[magnetic resonance imaging]] (MRI), has shown substantial progress in the detection of [[breast cancer]]. ==~~Operation~~Uses== Some of the uses of MRI of the breasts are: screening for malignancy in women with greater than 20% lifetime risk of breast cancer (especially those with high risk genes such as BRCA1 and BRCA2),<ref>{{Cite journal \|last1=Mann \|first1=Ritse M. \|last2=Cho \|first2=Nariya \|last3=Moy \|first3=Linda \|date=September 2019 \|title=Breast MRI: State of the Art \|url=http://pubs.rsna.org/doi/10.1148/radiol.2019182947 \|journal=Radiology \|language=en \|volume=292 \|issue=3 \|pages=520–536 \|doi=10.1148/radiol.2019182947 \|pmid=31361209 \|s2cid=198985377 \|issn=0033-8419\|doi-access=free \|hdl=2066/208973 \|hdl-access=free }}</ref> evaluate breast implants for rupture, screening the opposite side breast for malignancy in women with known one sided breast malignancy, extent of disease and the presence of multifocality and multicentricity in patients with invasive carcinoma and ductal carcinoma in situ (DCIS), and evaluate response to neoadjuvant chemotherapy.<ref>{{Cite web \|url=https://www.acr.org/~/media/2a0eb28eb59041e2825179afb72ef624.pdf \|title= ACR Practice Parameter for the Performance of Contrast-Enhanced Magnetic Resonance Imaging (MRI) of the Breast \|date=2013 \|publisher=[[American College of Radiology]] \|access-date=2017-11-11 \|archive-url=https://web.archive.org/web/20170623015816/https://www.acr.org/~/media/2a0eb28eb59041e2825179afb72ef624.pdf \|archive-date=2017-06-23 \|url-status=dead }}</ref> In this method, the breast is scanned in an MRI device before and after the intravascular injection of a [[contrast agent]] ([[Gadolinium]] DTPA). The pre-contrast images are "subtracted" from the post-contrast images, and any areas that have increased blood flow are seen as bright spots on a dark background. Since breast cancers generally have an increased blood supply, the contrast agent causes these lesions to "light up" on the images. MRI breasts has the highest sensitivity to detect breast cancer when compared with other imaging modalities such as [[breast ultrasound]] or [[mammography]]. In the screening for breast cancer for high-risk women, [[Sensitivity and specificity\|sensitivity]] of MRI range from 83 to 94% while specificity (the confidence that a lesion is cancerous and not a [[false positive]]) range from 75.2% to 100%.<ref name=Goscin2001>{{cite journal \| last1=Goscin \| first1=Christopher P. \| last2=Berman \| first2=Claudia G. \| last3=Clark \| first3=Robert A. \| title=Magnetic Resonance Imaging of the Breast \| journal=Cancer Control \| volume=8 \| issue=5 \| date=2001 \| doi=10.1177/107327480100800502 \| doi-access=free \| pmid=11579335 \| pages=399–406 \| url=http://www.medscape.com/viewarticle/409021_9}}</ref> ~~==Comparison to other technologies==~~ The available literature suggests that the sensitivity of contrast-enhanced breast MRI in detection of cancer is considerably higher than that of either radiographic mammography or [[ultrasound]] and is generally reported to be in excess of 95% (though not all reported studies have been as encouraging). ==Nephrogenic systemic fibrosis == The ''[[Sensitivity_and_specificity\|specificity]]'' (the confidence that a lesion is cancerous and not a [[false positive]]) is only fair,<ref name="pmid18342764">{{cite journal \|author=DeMartini W, Lehman C, Partridge S \|title=Breast MRI for cancer detection and characterization: a review of evidence-based clinical applications \|journal=Acad Radiol \|volume=15 \|issue=4 \|pages=408–16 \|year=2008 \|month=April \|pmid=18342764 \|doi=10.1016/j.acra.2007.11.006 \|url=http://linkinghub.elsevier.com/retrieve/pii/S1076-6332(07)00682-4}}</ref> thus a ''positive'' finding by MRI should not be interpreted as a definitive diagnosis. The systemic disease [[nephrogenic systemic fibrosis]] (NSF), caused by exposure to gadolinium in [[MRI contrast agent\|MRI contrast agents]], resembles [[scleromyxedema]] and to some extent [[scleroderma]]. It may occur months after contrast has been injected. Patients with poorer kidney function are more at risk for NSF, with dialysis patients being more at risk than patients with [[chronic kidney disease]]. After several years of controversy during which up to 100 Danish patients have been gadolinium poisoned (and some died) after use of the [[contrast agent]] Omniscan, the Norwegian medical company Nycomed admitted that they were aware of some dangers of using gadolinium-based agents for their product.<ref>{{Cite web \|title=Medicinalfirma fortiede at stof var farligt \|url=https://www.avisen.dk/medicinalfirma-fortiede-at-stof-var-farligt_6742.aspx \|access-date=2023-02-12 \|website=www.avisen.dk \|language=da}}</ref> At present, NSF has been linked to the use of four gadolinium-containing MRI contrast agents. The reports of 4,271 breast MRIs from eight large scale clinical trials were reviewed recently by CD Lehman.<ref>{{cite journal \| author=Lehman CD \| title="Role of MRI in screening women at high risk for breast cancer" \| journal=Journal of Magnetic Resonance Imaging \| volume=24 \| issue=5 \| year=2006 \| pages=964 \| pmid=17036340 \| doi=10.1002/jmri.20752}}</ref> Overall the sensitivity ranged from 71% to 100% in these reports, however the call-back rates were low at 10% and the risk of having a benign biopsy was reported at 5%, a significant improvement over mammography. Current indications for breast MRI include but are not limited to the screening of high-risk patients (such as those with a personal or strong family history of breast cancer), evaluation of breast implants in cases of suspected implant rupture, and pre-treatment evaluation of patients with newly diagnosed breast cancer to assess the extent of the disease) ~~==Vendors==~~ Several medical instrument vendors have entered this arena with breast MRI solutions. One company, Aurora Systems, is the only manufacturer to make a breast-dedicated unit and as the exclusive patent holder of certain solutions to fat signal suppression that appear to be more or less essential.{{Citation needed\|date=November 2009}} [[Siemens]], [[General Electric]] and Philips Medical, main manufacturers of MRI instruments, offer breast MRI products or add-ons, and several third-party companies offer aftermarket products to enable breast MRI on conventional MRI instruments. ==References== {{~~reflist~~Reflist}} ~~==See also==~~ * [[Breast cancer]] {{Breast procedures}} {{Medical imaging}} ~~{{medicine-stub}}~~ [[Category:Magnetic resonance imaging]] [[Category:Breast ~~cancer~~imaging]]