Abbreviated MRI Protocols in Breast Cancer Diagnosis: A Narrative Review

Background/Objectives: Breast MRI is the most sensitive modality for breast cancer detection, but long examination times, high costs, and limited availability restrict its use. Abbreviated breast MRI (AB-MRI) aims to preserve clinically relevant information while reducing acquisition and interpretation times. This narrative review summarizes evidence through 2026 on AB-MRI protocols, diagnostic performance, clinical applications, limitations, and emerging developments. Methods: Clinical studies, reviews, guidelines, implementation studies, and technical investigations of AB-MRI for screening, surveillance, preoperative assessment, neoadjuvant chemotherapy response, postoperative imaging, ultrafast MRI, diffusion-weighted imaging, artificial intelligence, and patient experience were reviewed. Results: AB-MRI can achieve diagnostic performance comparable to full-protocol MRI in selected screening and surveillance settings while substantially reducing scan and reading times. Multireader data in women with extremely dense breasts showed no significant differences in sensitivity or specificity versus full MRI. However, performance depends on protocol composition and clinical setting; T2-weighted imaging and DWI may improve specificity or diagnostic performance in selected applications. Recent studies also support sequential screening, surveillance after breast cancer, and neoadjuvant response assessment, while limitations remain for invasive lobular carcinoma, small lesions, non-mass enhancement, and disease extent. Emerging strategies include ultrafast MRI, adaptive AI-based imaging, AI-generated gadolinium-free contrast enhancement, and DWI-based protocol optimization. Conclusions: AB-MRI is best viewed as a flexible, indication-specific strategy rather than a single universal protocol. It is particularly promising for supplemental screening and surveillance, but prospective multicenter validation and protocol standardization remain necessary.