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Abbreviated Breast MR
Laura Heacock, MD; Linda Moy, MD
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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
            • 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

                                          1. Deike-Hofmann K et al: Abbreviated MRI Protocols in Breast Cancer Diagnostics. J Magn Reson Imaging. 49(3):647-658, 2019
                                          2. 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
                                          3. Oldrini G et al: Impact of an abbreviated protocol for breast MRI in diagnostic accuracy. Diagn Interv Radiol. 24(1):12-16, 2018
                                          4. Chen SQ et al: Abbreviated MRI protocols for detecting breast cancer in women with dense breasts. Korean J Radiol. 18(3):470-475, 2017
                                          5. 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
                                          6. Kuhl CK et al: Supplemental breast MR imaging screening of women with average risk of breast cancer. Radiology. 283(2):361-370, 2017
                                          7. 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
                                          8. 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
                                          9. 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
                                          10. 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
                                          11. 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
                                          12. 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
                                          13. 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
                                          14. 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
                                          15. 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
                                          16. 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
                                          17. Moschetta M et al: Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions. Clin Breast Cancer. 16(3):207-11, 2016
                                          18. 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
                                          19. 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
                                          20. Grimm LJ et al: Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 22(9):1157-62, 2015
                                          21. Mango VL et al: Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection? Eur J Radiol. 84(1):65-70, 2015
                                          22. 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
                                          23. 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
                                          24. 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
                                          25. Tudorica LA et al: A feasible high spatiotemporal resolution breast DCE-MRI protocol for clinical settings. Magn Reson Imaging. 30(9):1257-67, 2012
                                          26. 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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                                          Related Differential Diagnoses
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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
                                                    • 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

                                                                                  1. Deike-Hofmann K et al: Abbreviated MRI Protocols in Breast Cancer Diagnostics. J Magn Reson Imaging. 49(3):647-658, 2019
                                                                                  2. 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
                                                                                  3. Oldrini G et al: Impact of an abbreviated protocol for breast MRI in diagnostic accuracy. Diagn Interv Radiol. 24(1):12-16, 2018
                                                                                  4. Chen SQ et al: Abbreviated MRI protocols for detecting breast cancer in women with dense breasts. Korean J Radiol. 18(3):470-475, 2017
                                                                                  5. 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
                                                                                  6. Kuhl CK et al: Supplemental breast MR imaging screening of women with average risk of breast cancer. Radiology. 283(2):361-370, 2017
                                                                                  7. 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
                                                                                  8. 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
                                                                                  9. 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
                                                                                  10. 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
                                                                                  11. 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
                                                                                  12. 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
                                                                                  13. 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
                                                                                  14. 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
                                                                                  15. 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
                                                                                  16. 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
                                                                                  17. Moschetta M et al: Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions. Clin Breast Cancer. 16(3):207-11, 2016
                                                                                  18. 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
                                                                                  19. 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
                                                                                  20. Grimm LJ et al: Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 22(9):1157-62, 2015
                                                                                  21. Mango VL et al: Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection? Eur J Radiol. 84(1):65-70, 2015
                                                                                  22. 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
                                                                                  23. 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
                                                                                  24. 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
                                                                                  25. Tudorica LA et al: A feasible high spatiotemporal resolution breast DCE-MRI protocol for clinical settings. Magn Reson Imaging. 30(9):1257-67, 2012
                                                                                  26. 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