American College of Radiology (ACR) accreditation standards
Slice thickness < 3 mm
Slice gap = 0 mm
In plane pixel resolution (phase and frequency) < 1 mm
AB-MR
Breast screening exam with total scan time < 10 minutes, including localizer sequence
No current ACR accreditation standards
Short scan time allows faster throughput, ↑ availability of screening breast MR to intermediate-risk women (lifetime breast cancer risk of 15-20%)
Rapid interpretation time with similar cancer yield and diagnostic accuracy compared to FDP
AB-MR C+ protocol
1.5 or 3T magnet with dedicated breast coil; power injector
Minimum requirement: 1 pre- and 1 postcontrast axial T1 GRE acquisition at 60-90 seconds with subtraction images
Fat saturation optional; stabilization beneficial to ↓ motion if no fat saturation used
Optional: Maximum-intensity projection (MIP) from subtraction images
Optional: Precontrast T2/STIR
Sensitivity of 86-100%, with interpretation times of 25-180 seconds in retrospective reader studies
AB-MR C- protocol
Given concern for Gd deposition, motivation for noncontrast protocol
Can include T1 GRE, diffusion-weighted imaging (DWI), and corresponding apparent diffusion coefficient (ADC) maps, T2/STIR
Resolution remains suboptimal
Faster interpretation time (~ 30 seconds) but lower sensitivity (45-92%)
Remains investigational; total scan time: 6-8 minutes
Fast temporal resolution AB-MR
Temporal resolution of < 10 seconds (compared to 90-120 seconds for standard breast MR)
Center of k-space sampled at beginning of acquisition (60 seconds post contrast)
Long off-line reconstruction time (currently > 1 hour)
↑ temporal resolution has current trade-off of ↓ spatial resolution; generally combined with single high spatial resolution acquisition following fast temporal resolution imaging
Remains experimental
Facility must have MR biopsy capability
General Performance Statistics
Studies performed across different populations (enriched vs. pure screening) and varying protocols
Sensitivity: 81.8-100%
Specificity: 45-94%
PPV of biopsies: > 22% all prospective series
NPV: 87-99.8%
Cancer detection rate
19/1,000 (range: 9-36) in initial (prevalence) screening round
Interval cancer rate
Currently unknown
IMAGING
General Features
MR Findings
Indications
Contraindications
Ultrasonographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
AB-MR Literature
Benefits
Limitations
BI-RADS Considerations
Billing
Additional Screening Modalities
DIAGNOSTIC CHECKLIST
Consider
Selected References
Deike-Hofmann K et al: Abbreviated MRI Protocols in Breast Cancer Diagnostics. J Magn Reson Imaging. 49(3):647-658, 2019
Dogan BE et al: American College of Radiology-compliant short protocol breast MRI for high-risk breast cancer screening: a prospective feasibility study. AJR Am J Roentgenol. 210(1):214-21, 2018
Oldrini G et al: Impact of an abbreviated protocol for breast MRI in diagnostic accuracy. Diagn Interv Radiol. 24(1):12-16, 2018
Chen SQ et al: Abbreviated MRI protocols for detecting breast cancer in women with dense breasts. Korean J Radiol. 18(3):470-475, 2017
Heacock L et al: Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness. J Magn Reson Imaging. ePub, 2017
Kuhl CK et al: Supplemental breast MR imaging screening of women with average risk of breast cancer. Radiology. 283(2):361-370, 2017
Oldrini G et al: Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization. Eur J Radiol. 95:177-185, 2017
Panigrahi B et al: An abbreviated protocol for high-risk screening breast magnetic resonance imaging: Impact on performance metrics and BI-RADS assessment. Acad Radiol. 24(9):1132-1138, 2017
Petrillo A et al: Abbreviated breast dynamic contrast-enhanced MR imaging for lesion detection and characterization: the experience of an Italian oncologic center. Breast Cancer Res Treat. 164(2):401-410, 2017
Romeo V et al: Preliminary results of a simplified breast MRI protocol to characterize breast lesions: Comparison with a full diagnostic protocol and a Review of the Current Literature. Acad Radiol. 24(11):1387-1394, 2017
Strahle DA et al: Systematic development of an abbreviated protocol for screening breast magnetic resonance imaging. Breast Cancer Res Treat. 162(2):283-295, 2017
Clinicaltrials.gov: Comparison of abbreviated breast MRI and digital breast tomosynthesis in breast cancer screening in women with dense breasts. https://clinicaltrials.gov/ct2/show/NCT02933489. Published October 14, 2016. Updated December 11, 2017. Accessed June 1, 2018
Abe H et al: Kinetic analysis of benign and malignant breast lesions with ultrafast dynamic contrast-enhanced MRI: Comparison with standard kinetic assessment. AJR Am J Roentgenol. 207(5):1159-1166, 2016
Bickelhaupt S et al: Fast and noninvasive characterization of suspicious lesions detected at breast cancer X-ray screening: Capability of diffusion-weighted MR imaging with MIPs. Radiology. 278(3):689-97, 2016
Harvey SC et al: An abbreviated protocol for high-risk screening breast MRI saves time and resources. J Am Coll Radiol. 13(11S):R74-R80, 2016
Heacock L et al: Evaluation of a known breast cancer using an abbreviated breast MRI protocol: Correlation of imaging characteristics and pathology with lesion detection and conspicuity. Eur J Radiol. 85(4):815-23, 2016
Moschetta M et al: Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions. Clin Breast Cancer. 16(3):207-11, 2016
Pineda FD et al: Ultrafast Bilateral DCE-MRI of the Breast with Conventional Fourier Sampling: Preliminary Evaluation of Semi-quantitative Analysis. Acad Radiol. 23(9):1137-44, 2016
Sung JS et al: Breast cancers detected at screening MR imaging and mammography in patients at high risk: Method of detection reflects tumor histopathologic results. Radiology. 280(3):716-22, 2016
Grimm LJ et al: Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 22(9):1157-62, 2015
Mango VL et al: Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection? Eur J Radiol. 84(1):65-70, 2015
Kuhl CK et al: Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 32(22):2304-10, 2014
Mann RM et al: A novel approach to contrast-enhanced breast magnetic resonance imaging for screening: high-resolution ultrafast dynamic imaging. Invest Radiol. 49(9):579-85, 2014
Rahbar H et al: In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. 263(2):374-82, 2012
Tudorica LA et al: A feasible high spatiotemporal resolution breast DCE-MRI protocol for clinical settings. Magn Reson Imaging. 30(9):1257-67, 2012
Kuhl CK et al: Dynamic bilateral contrast-enhanced MR imaging of the breast: trade-off between spatial and temporal resolution. Radiology. 236:789-800, 2005
American College of Radiology (ACR) accreditation standards
Slice thickness < 3 mm
Slice gap = 0 mm
In plane pixel resolution (phase and frequency) < 1 mm
AB-MR
Breast screening exam with total scan time < 10 minutes, including localizer sequence
No current ACR accreditation standards
Short scan time allows faster throughput, ↑ availability of screening breast MR to intermediate-risk women (lifetime breast cancer risk of 15-20%)
Rapid interpretation time with similar cancer yield and diagnostic accuracy compared to FDP
AB-MR C+ protocol
1.5 or 3T magnet with dedicated breast coil; power injector
Minimum requirement: 1 pre- and 1 postcontrast axial T1 GRE acquisition at 60-90 seconds with subtraction images
Fat saturation optional; stabilization beneficial to ↓ motion if no fat saturation used
Optional: Maximum-intensity projection (MIP) from subtraction images
Optional: Precontrast T2/STIR
Sensitivity of 86-100%, with interpretation times of 25-180 seconds in retrospective reader studies
AB-MR C- protocol
Given concern for Gd deposition, motivation for noncontrast protocol
Can include T1 GRE, diffusion-weighted imaging (DWI), and corresponding apparent diffusion coefficient (ADC) maps, T2/STIR
Resolution remains suboptimal
Faster interpretation time (~ 30 seconds) but lower sensitivity (45-92%)
Remains investigational; total scan time: 6-8 minutes
Fast temporal resolution AB-MR
Temporal resolution of < 10 seconds (compared to 90-120 seconds for standard breast MR)
Center of k-space sampled at beginning of acquisition (60 seconds post contrast)
Long off-line reconstruction time (currently > 1 hour)
↑ temporal resolution has current trade-off of ↓ spatial resolution; generally combined with single high spatial resolution acquisition following fast temporal resolution imaging
Remains experimental
Facility must have MR biopsy capability
General Performance Statistics
Studies performed across different populations (enriched vs. pure screening) and varying protocols
Sensitivity: 81.8-100%
Specificity: 45-94%
PPV of biopsies: > 22% all prospective series
NPV: 87-99.8%
Cancer detection rate
19/1,000 (range: 9-36) in initial (prevalence) screening round
Interval cancer rate
Currently unknown
IMAGING
General Features
MR Findings
Indications
Contraindications
Ultrasonographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
AB-MR Literature
Benefits
Limitations
BI-RADS Considerations
Billing
Additional Screening Modalities
DIAGNOSTIC CHECKLIST
Consider
Selected References
Deike-Hofmann K et al: Abbreviated MRI Protocols in Breast Cancer Diagnostics. J Magn Reson Imaging. 49(3):647-658, 2019
Dogan BE et al: American College of Radiology-compliant short protocol breast MRI for high-risk breast cancer screening: a prospective feasibility study. AJR Am J Roentgenol. 210(1):214-21, 2018
Oldrini G et al: Impact of an abbreviated protocol for breast MRI in diagnostic accuracy. Diagn Interv Radiol. 24(1):12-16, 2018
Chen SQ et al: Abbreviated MRI protocols for detecting breast cancer in women with dense breasts. Korean J Radiol. 18(3):470-475, 2017
Heacock L et al: Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness. J Magn Reson Imaging. ePub, 2017
Kuhl CK et al: Supplemental breast MR imaging screening of women with average risk of breast cancer. Radiology. 283(2):361-370, 2017
Oldrini G et al: Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization. Eur J Radiol. 95:177-185, 2017
Panigrahi B et al: An abbreviated protocol for high-risk screening breast magnetic resonance imaging: Impact on performance metrics and BI-RADS assessment. Acad Radiol. 24(9):1132-1138, 2017
Petrillo A et al: Abbreviated breast dynamic contrast-enhanced MR imaging for lesion detection and characterization: the experience of an Italian oncologic center. Breast Cancer Res Treat. 164(2):401-410, 2017
Romeo V et al: Preliminary results of a simplified breast MRI protocol to characterize breast lesions: Comparison with a full diagnostic protocol and a Review of the Current Literature. Acad Radiol. 24(11):1387-1394, 2017
Strahle DA et al: Systematic development of an abbreviated protocol for screening breast magnetic resonance imaging. Breast Cancer Res Treat. 162(2):283-295, 2017
Clinicaltrials.gov: Comparison of abbreviated breast MRI and digital breast tomosynthesis in breast cancer screening in women with dense breasts. https://clinicaltrials.gov/ct2/show/NCT02933489. Published October 14, 2016. Updated December 11, 2017. Accessed June 1, 2018
Abe H et al: Kinetic analysis of benign and malignant breast lesions with ultrafast dynamic contrast-enhanced MRI: Comparison with standard kinetic assessment. AJR Am J Roentgenol. 207(5):1159-1166, 2016
Bickelhaupt S et al: Fast and noninvasive characterization of suspicious lesions detected at breast cancer X-ray screening: Capability of diffusion-weighted MR imaging with MIPs. Radiology. 278(3):689-97, 2016
Harvey SC et al: An abbreviated protocol for high-risk screening breast MRI saves time and resources. J Am Coll Radiol. 13(11S):R74-R80, 2016
Heacock L et al: Evaluation of a known breast cancer using an abbreviated breast MRI protocol: Correlation of imaging characteristics and pathology with lesion detection and conspicuity. Eur J Radiol. 85(4):815-23, 2016
Moschetta M et al: Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions. Clin Breast Cancer. 16(3):207-11, 2016
Pineda FD et al: Ultrafast Bilateral DCE-MRI of the Breast with Conventional Fourier Sampling: Preliminary Evaluation of Semi-quantitative Analysis. Acad Radiol. 23(9):1137-44, 2016
Sung JS et al: Breast cancers detected at screening MR imaging and mammography in patients at high risk: Method of detection reflects tumor histopathologic results. Radiology. 280(3):716-22, 2016
Grimm LJ et al: Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 22(9):1157-62, 2015
Mango VL et al: Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection? Eur J Radiol. 84(1):65-70, 2015
Kuhl CK et al: Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 32(22):2304-10, 2014
Mann RM et al: A novel approach to contrast-enhanced breast magnetic resonance imaging for screening: high-resolution ultrafast dynamic imaging. Invest Radiol. 49(9):579-85, 2014
Rahbar H et al: In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. 263(2):374-82, 2012
Tudorica LA et al: A feasible high spatiotemporal resolution breast DCE-MRI protocol for clinical settings. Magn Reson Imaging. 30(9):1257-67, 2012
Kuhl CK et al: Dynamic bilateral contrast-enhanced MR imaging of the breast: trade-off between spatial and temporal resolution. Radiology. 236:789-800, 2005
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