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KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Abbreviated breast MR (AB-MR)
Definitions
- Full diagnostic protocol (FDP)
- Minimum: 1 pre- and 2 postcontrast T1 gradient echo (GRE) acquisitions, T2/STIR
- 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
- Full diagnostic protocol (FDP)
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
- Studies performed across different populations (enriched vs. pure screening) and varying protocols
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
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Abbreviated breast MR (AB-MR)
Definitions
- Full diagnostic protocol (FDP)
- Minimum: 1 pre- and 2 postcontrast T1 gradient echo (GRE) acquisitions, T2/STIR
- 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
- Full diagnostic protocol (FDP)
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
- Studies performed across different populations (enriched vs. pure screening) and varying protocols
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
