Breast MRI is a non-invasive procedure using magnetic resonance imaging (MRI) that allows doctors to see what the inside of the breast looks like to diagnose and treat medical conditions. It provides valuable information about breast tissue and potential lesions/tumors that cannot be obtained by other imaging modalities, such as mammography or ultrasound.
There are two kinds of breast MRI exams—with contrast or without contrast. Contrast is a special dye that helps highlight breast tissue.
Breast MRI with contrast is used to:
- Provide further data after an inconclusive mammogram, ultrasound or physical exam
- Screen certain high-risk patients
- Detect breast cancer and/or determine the extent of the disease
- Assist with the consideration of treatment options • Monitor breast cancer chemotherapy
Breast MRI without contrast is used to:
- Evaluate breast implants
- Determine if rupture or leakage has occurred.
MRI of the breast is not a replacement for mammography or ultrasound imaging, but rather a supplemental tool for detecting and staging breast cancer and other breast abnormalities. However, ongoing medical studies have shown that MRI is substantially more accurate for early diagnosis of breast cancer than digital mammography or breast ultrasound.
A breast MRI exam is safe, simple and painless. However, please notify us for further instructions if:
- You are pregnant or could be pregnant.
- You have a pacemaker, defibrillator, heart valve, cochlear implant or neurostimulator.
- You have a history of metal in the eyes.
Pacemakers, defibrillators and cochlear implants are contraindications to MRI scanning due to the high magnetic field used. Other implant devices such as hip or knee prosthesis, surgical clips or pins and cardiac stents that have been in place for more than six weeks pose no problem.
Some heart valves, aneurysm clips and neurostimulators are not safe. Bring the implant certificate with you so the technologists can refer to the manufacturer’s information about MRI compatibility.
- Prior to your scheduled appointment, Overlake will call you to discuss specific instructions, review your health and insurance information and answer any questions.
- If you’ve had an allergic reaction to a contrast agent in any prior imaging exam, please notify our staff before your appointment.
- Contrast breast exams are best performed between days 7-12 of your menstrual cycle.
- Prior to the exam, eat normally and take your medication as usual (unless your physician has given you other instructions.)
- Leave your valuables at home. All jewelry and any metal objects must be removed prior to the exam.
- Wear comfortable clothing without zippers, snaps or metal buttons. Or, you may change into a hospital gown or scrubs after arriving.
- Please notify the technologist if you are pregnant or could be pregnant. Or, if you are breastfeeding.
- Please bring all relevant prior examination films or studies (mammography, ultrasound, MRI, etc.) with you on the day of your exam.
- For your listening pleasure during the exam, Overlake has I-pods with a library of music you can select from when you arrive.
- If sedation is requested, please call for instructions. You will need to arrange for someone to drive you home.
- Please arrive 30 minutes prior to your exam.
What to Expect During Exam
- Allow between 60 and 90 minutes for the procedure.
- For your comfort, you may have someone accompany you during the exam. He or she will be able to sit and talk with you during the procedure.
- If necessary, physician-administered medication is available to help you relax.
- A technologist will help position you on the cushioned scanning table. You will lie face down on your stomach with both breasts hanging freely in a padded depression in the table containing a breast coil which detects magnetic signals from the MRI machine. Your head will be positioned on a headrest equipped with mirrors so you can see out of the scanner during the exam. Your arms will be positioned above your head.
- If a contrast material will be used, the technologist will insert an intravenous (IV) line into a vein in your hand or arm. A saline solution may be used. The solution will drip through the IV to prevent blockage of the IV line until the contrast material is injected.
- To minimize scanner noises, you will be given earplugs or you can listen to a music I-Pod through an audio headset.
- The scanner bed will slide into the magnet of the MRI unit. The technologist will leave the room during the scan, but you will remain in contact via an intercom and the mirrors.
- As the scan begins, you will hear knocking or buzzing sounds for a few minutes at a time as images are captured. It is important to lie as still as possible and breathe normally during this imaging process. Some movement is allowed between sequences.
- After an initial series of scans, if contrast is to be used, Gadolinium (an FDA-approved, non-radioactive contrast agent) will be injected into the IV. You will feel a warm, flushed sensation and may experience a metallic taste in your mouth that lasts a few minutes.
- An additional series of images will be taken during or following the injection.
What to Expect After Exam
- You may leave as soon as the exam is completed and resume normal activities.
- Your normal diet may be resumed.
- If IV contrast was used, it will rapidly be cleared from the body by the kidneys. However, women who are breastfeeding should discard milk for 48 hours after the exam.
- Your imaging study will be interpreted by a board certified radiologist who specializes in breast imaging.
- Your referring physician will receive a report and pictures detailing the findings of your exam within 24 hour. You should contact your doctor to discuss the results.
Who is a Candidate?
- Newly diagnosed breast cancer patients. A breast MRI will provide more accurate information about tumor size and shape, allowing the surgeon to properly plan treatment. MRI will also help assure that there are no additional areas of cancer in the same breast or on the opposite side. Women contemplating lumpectomy often have anxiety about cancer being present in the remaining breast tissue. A breast MRI can provide the reassurance that the cancer is limited to one site. Also, in this era of “partial breast radiation,” the remaining breast tissue away from the lumpectomy site is not treated, so breast MRI is an excellent tool to help patients select this approach.
- Patients with a past history of breast cancer. Women who have undergone lumpectomy and radiation often have scar tissue seen on mammography that can mask a recurrent cancer. Incorporating MRI into the follow-up plan vastly improves the chances of early detection. For women who have undergone mastectomy on one side, there is still a possibility of recurrence of the original tumor, plus the other breast is at increased risk for the development of a new primary breast cancer. Again, MRI is the most sensitive method of detection. Women who have already had bilateral mastectomies may still want to continue with MRI follow-up if they are at risk of local recurrence, especially if they have undergone a reconstruction that can interfere with early detection.
- Diagnostic problems not settled by conventional imaging. Usually, breast concerns are completely evaluated through the use of mammography and ultrasound. However, if questions remain, breast MRI can offer great diagnostic assistance.
- Implant status. Breast implants placed as part of cancer reconstruction are studied with MRI as part of routine follow-up. This is generally covered by insurance. When silicone implants are placed for cosmetic reasons, the FDA's new guidelines recommend breast MRI after 3 years, then every 2 years thereafter. Insurance coverage is less likely here (unless patients qualify for MRI based on other indications).
- Asymptomatic screening.Yearly breast MRI, in addition to mammography, beginning at age 30 is now recommended by the ACS for women who:
- Test positive for one of the BRCA genes, or a first-degree relative of a known BRCA mutation carrier,
- Have a documented history of any of the rare genetic disorders in which breast cancer is one component,
- Have a past history of being treated with chest irradiation for Hodgkin’s disease between ages 10 and 30, or
- Have been calculated by any of the standard mathematical models to have a 20-25% (or greater) lifetime risk for the development of breast cancer.
Common Indications for Breast MRI?
- Breast cancer staging. Extent of disease evaluation prior to breast conservation surgery or mastectomy
- Contralateral breast examination in patients with breast malignancy. MRI can detect unsuspected disease in the opposite breast in at least 4-5% of breast cancer patients—often with negative mammography and physical examination.
- Lesion characterization. When conventional breast imaging studies such as mammography, ultrasound or physical examination are inconclusive for the presence of breast cancer
- Monitoring chemotherapy treatment. To evaluate chemotherapeutic response and the extent of residual disease prior to surgical treatment
- Evaluating patients with positive surgical margins for residual disease. To help determine which patients could be effectively treated by re-excision or whether a mastectomy is required due to the presence of more extensive disease.
- Silicone and non-silicone breast implant evaluation. Evaluating breast implants for rupture and detecting cancer in women with breast implants
- Evaluating post-operative scar versus tumor recurrence.
- Occult breast cancer. Locating the very small, undiagnosed breast cancer (occult cancer) when a malignant axillary node is found and the origin cannot be determined with mammography or physical examination.
- Surveillance of high risk patients. Breast cancer screening in patients with a genetic predisposition to breast cancer.
Who Interprets the Breast MRI?
A highly trained breast imaging technologist, under the direction of a dedicated board certified radiologist who only interprets breast MRI’s, mammograms and breast ultrasounds, performs the study. Other imaging centers may use technologists who take many different types of x-rays and scans.
Yes. Most policies do require a referral and a pre-certification. You should check with your insurance company. If pre-certification is required, tell us when you make an appointment and we will take care of it.