MR imaging of the breast--present indications

MRI of the breast has proved its role in the diagnosis of breast cancer. Despite the amount of studies with MRI, the technique has not been standardised yet. This is one of the reasons for the huge difference in specificity the reported in the different studies (from 30% to 95%). Because the many pitfalls of the technique, the specificity of MRI of the breast is correlated to the experience of the investigator. When the established indications are respected, specificity increases. Presently accepted indications are: differentiation between postoperative fibrosis and tumor recurrence, multifocality or contralateral breast carcinoma, evaluation of prosthesis, discrepancy between the different diagnostic techniques, high risk patients with dense breasts. Less frequently but nevertheless a good indication is proven axillary lymph node metastases from an unknown primary tumor. Microcalcifications still are not a good indication for MRI of the breast. MRI is still inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas because the neo-angiogenesis of these tumors is too faint to be detected by contrast-enhanced MRI. MRI instead of mammography or to solve a problem resulting from a bad mammographical examination is certainly not advised. New sequences, including diffusion and perfusion, and new contrast agents are keenly awaited.