Contrast-enhanced magnetic resonance imaging of the breast: interpretation guidelines

In the past decade, most studies have shown that in selected indications of breast imaging, the overall accuracy can be improved by the additional use of contrast-enhanced magnetic resonance imaging (MRI). The sensitivity of contrast-enhanced MRI for invasive malignancy is >98%; reported specificity, however, ranges from 37% to 97%. This range of values is predominantly caused by different patient preselection and interpretation criteria. Other factors, such as technique (e.g., choice of pulse sequence and echo time, slice thickness, reduction in artifacts, dosage of contrast agent, and methods for elimination of fat signal), hormonal influences (menstrual cycle and hormonal replacement therapy), and levels of verification, influence the accuracy and reproducibility of contrast-enhanced MRI. An appropriate application of MRI is highly desirable because of the increased costs of imaging, increased rates of biopsy due to false-positive results, and possibility of false-negative results caused by technical failures and interpretation errors. We present an overview of the sensible application and interpretation of contrast-enhanced MRI of the breast based on our experience and on published data.