Breast MRI Order Name for High-Risk Screening
The appropriate order name is "MRI Breast Without and With IV Contrast" or "Contrast-Enhanced Breast MRI" for breast cancer screening in high-risk women. 1, 2
Standard Nomenclature
The American College of Radiology specifies that breast MRI screening must always include intravenous gadolinium-based contrast administration, as there is no role for breast MRI without contrast in clinical practice. 2
The technical term used in clinical ordering systems is typically "MRI Breast Without and With Contrast" or "Bilateral Breast MRI with Contrast" to indicate the complete protocol that includes pre-contrast and post-contrast imaging sequences. 1
This examination utilizes dynamic contrast-enhanced (DCE) MRI technique, which involves collecting pre-injection images followed by sequential post-contrast images at early time points (typically 1-3 minutes after injection) to assess enhancement patterns. 1
Technical Requirements for Valid Screening
The order must specify use of a dedicated breast coil rather than body, chest, or abdominal coils to produce diagnostically adequate high-quality images. 1
The facility must have MRI-guided biopsy capability available, as many early cancers are detected only on MRI and require MRI-guided tissue sampling. 3
High spatial resolution imaging with a high field magnet is required to meet American College of Radiology technical standards. 3
Clinical Context for Ordering
This examination is indicated for high-risk women including:
BRCA1/2 mutation carriers or untested first-degree relatives, beginning at age 25-30. 1, 3
Women with ≥20% lifetime breast cancer risk calculated by risk models, starting at age 30. 1, 3
Women with history of chest radiation ≥10 Gy before age 30, beginning at age 25 or 8 years after radiation completion. 1, 3
Women with personal history of breast cancer diagnosed before age 50. 1, 3
Performance Characteristics
Contrast-enhanced breast MRI demonstrates sensitivity of 71-100% for breast cancer detection in high-risk populations, substantially exceeding mammography's 31-37% sensitivity. 1, 4
The cancer detection rate is 8-29 per 1,000 examinations in elevated-risk women, detecting smaller node-negative invasive cancers at earlier stages. 3, 5
Non-contrast MRI cannot differentiate between benign and malignant lesions and has no role in breast cancer screening or diagnosis. 2
Important Ordering Considerations
Avoid scheduling during days 1-6 or 22-28 of the menstrual cycle in premenopausal women due to hormonal effects on background parenchymal enhancement that can reduce diagnostic accuracy. 2
The examination requires experienced radiologists for interpretation, as there is a learning curve with initial community practice callback rates exceeding 50%. 3
Recall rates are 15.1% and biopsy rates are 11.8%, with positive predictive value for biopsy (PPV3) ranging 36-48% depending on radiologist experience. 3