Breast MR with special focus on DW-MRI and DCE-MRI

Area of Science:

• Radiology and Imaging Science
• Oncology Imaging
• Breast Cancer Diagnostics

Background:

• Magnetic resonance imaging (MRI) for breast lesion assessment, though described in the 1970s, has only recently seen wide clinical application.
• Diagnostic principles involve evaluating T2-weighted signal intensity, morphology, and contrast enhancement behavior.
• Emerging techniques like dynamic contrast-enhanced (DCE) MRI and diffusion-weighted MRI (DW-MRI) offer advanced insights.

Purpose of the Study:

• To review the established and emerging roles of breast MRI in the comprehensive work-up of breast lesions.
• To highlight the utility of MRI in specific clinical scenarios including multifocal disease, contralateral carcinoma detection, and familial disposition.
• To evaluate the application of breast MRI in monitoring neoadjuvant chemotherapy and assessing therapeutic response and residual tumor.

Main Methods:

• Review of established MRI principles for breast lesion diagnosis, including T2-weighted imaging and contrast enhancement evaluation.
• Integration of advanced MRI techniques: dynamic contrast-enhanced (DCE) MRI for contrast behavior quantification and diffusion-weighted (DW-MRI) for water molecule diffusivity.
• Assessment of MRI's role in diverse clinical indications: detection, neoadjuvant chemotherapy monitoring, and postoperative evaluation.

Main Results:

• Breast MRI demonstrates high sensitivity for detecting multifocal lesions, contralateral carcinomas, and in high-risk patients.
• DCE-MRI and DW-MRI show potential for early assessment of tumor response to therapy and evaluation of residual tumor.
• Postoperative MRI exhibits high sensitivity and specificity for recurrence detection, though careful consideration of pitfalls like liponecrosis is necessary.

Conclusions:

• Breast MRI is a valuable tool for various indications due to its high sensitivity, particularly in complex cases and treatment monitoring.
• Advanced techniques like DCE-MRI and DW-MRI enhance diagnostic accuracy and therapeutic assessment capabilities.
• While effective for recurrence detection, careful interpretation is crucial to mitigate potential diagnostic challenges in the postoperative setting.