Breast MR imaging for cancer detection and implant evaluation: potential pitfalls

Magnetic resonance (MR) imaging of the breast is currently used for evaluation of both parenchymal disease and silicone gel implants. MR imaging has the potential to address questions raised or unanswered with traditional diagnostic imaging methods. However, lesion specificity and cancer sensitivity depend on multiple technical factors (i.e., imaging parameters and contrast agent delivery) and biologic factors (i.e., the menstrual status of the patient and the vascularity of the lesion). Although diagnostic criteria for parenchymal disease have been reported, overlap of malignant and benign enhancement profiles occurs. The accuracy of implant evaluation depends on the imaging parameters and knowledge of the implant type and surgical history. In addition, individual investigative imaging methods are diverse, causing difficulty in protocol development for the practicing radiologist. An awareness of the problematic factors in breast MR imaging will improve diagnostic accuracy and allow understanding of the limitations of the modality and individual patient examinations.