From the Guidelines
Contrast-Enhanced Breast MRI is the best type of MRI for breast cancer detection. This is based on the most recent and highest quality study available, which shows that contrast-enhanced breast MRI has a higher sensitivity for breast cancer detection compared to mammography and ultrasound, especially in high-risk populations 1.
Key Points
- The sensitivity of contrast-enhanced breast MRI for breast cancer detection is 90.0% compared to 37.5% for mammography and 37.5% for ultrasound in high-risk populations 1.
- Contrast-enhanced breast MRI is particularly valuable for high-risk patients, those with dense breast tissue, and when conventional imaging is inconclusive.
- The procedure typically takes 30-60 minutes and requires lying face down on a specialized breast coil.
- For optimal results, premenopausal women should schedule the exam during days 7-14 of their menstrual cycle to minimize background enhancement that could obscure findings.
Benefits of Contrast-Enhanced Breast MRI
- Higher sensitivity for breast cancer detection compared to mammography and ultrasound
- Ability to detect small tumors that other imaging might miss
- Valuable for high-risk patients and those with dense breast tissue
- Can reveal invasive lobular carcinoma more effectively than standard mammography
Limitations of Contrast-Enhanced Breast MRI
- Higher cost compared to mammography and ultrasound
- Limited availability
- Potential for false positives
- Requires the use of a contrast agent (gadolinium) which may have adverse effects in some patients.
From the FDA Drug Label
The within-subject sensitivity of gadobutrol injection BMR was superior to that of BMR The lower bound of the 95% Confidence Interval (CI) for the difference in within-subject sensitivity ranged from 19% to 42% for Study 1 and from 12% to 27% for Study 2. Gadobutrol injection is indicated for use with MRI in adult patients to assess the presence and extent of malignant breast disease.
Gadobutrol-enhanced Breast MRI is the best type of MRI for breast cancer detection, as it has been shown to have superior sensitivity compared to non-contrast breast MRI. The use of gadobutrol injection in breast MRI has been found to improve the detection of malignant breast disease, with a higher sensitivity and specificity compared to non-contrast MRI 2.
From the Research
Types of MRI for Breast Cancer Detection
- Unenhanced MRI using T2-weighted and diffusion-weighted imaging can be used for breast cancer detection, with a diagnostic accuracy comparable to contrast-enhanced MRI 3
- Contrast-enhanced MRI is highly sensitive for breast cancer detection, with sensitivity ranging from 81% to 100% 4
- Unenhanced MRI protocols composed of T1-weighted gradient echo, T2-weighted STIR, and echo-planar diffusion-weighted imaging can enable breast cancer detection with sensitivity of 76-78% and specificity of 90% 5
Comparison of MRI Techniques
- Contrast-enhanced MRI has a higher sensitivity than mammography for breast cancer detection, especially for invasive and aggressive types of cancer 4
- Unenhanced MRI may not be as effective in detecting ductal carcinoma in situ, but has comparable diagnostic accuracy to contrast-enhanced MRI for other types of breast cancer 3
- Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers a comprehensive 3-dimensional assessment of extent of disease and characterization of lesions, capturing both morphological and functional aspects 6
Clinical Applications
- Breast MRI is recommended as a supplemental screening tool to mammography and breast ultrasound for breast cancer detection, especially for women with a high risk of breast cancer 7
- Contrast-enhanced MRI can be used for preoperative staging, tumor size estimation, and detection of additional tumor foci in the ipsilateral and contralateral breast 7, 6
- Unenhanced MRI may be beneficial for reducing costs and improving accessibility of breast cancer screening, especially with the use of abbreviated protocols 3, 4