Gadolinium-enhanced breast MRI

The inherent overlap in the T1 and T2 relaxation of benign and malignant breast lesions has hindered progress in the application of MRI to evaluate this organ. Indeed, lesions in a glandular breast may completely blend in with normal breast tissues, a problem unenhanced MRI shares with mammography. However, infusion of intravenous Gd-DPTA accompanied by rapid MR imaging results in successful detection of most invasive breast malignancies. Inspection of the lesion morphology and enhancement profile shows that most malignancies have an irregular border, enhance very rapidly, and display a distinct early washout phase. On the other hand, fibroadenomas have a smooth or gently lobulated border and enhance in a continuous monotonic fashion. Some pitfalls exist such as the variable enhancement associated with DCIS and premenopausal breast tissue. This publication reviews the literature with respect to Gd-enhanced breast MRI, focusing on strengths and weaknesses, and suggests appropriate indications for employing this new approach to breast imaging. Patient preparation and discussion of technical parameters and tradeoffs is also addressed. The exact place of MRI in the work-up of the breast-problem patient has yet to be settled, but already MRI can help radiologists offer a more conclusive diagnosis in mammographically perplexing situations, particularly in patients with radiographically dense breasts.