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Magnetic Resonance Breast Imaging

 

                             

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Magnetic resonance breast imaging has been approved since 1991 by the FDA for use as a supplemental tool in addition to mammography in diagnosing breast cancer.

 

Breast MRI is an excellent diagnostic procedure in the following:

 

The American Cancer Society recommends women who are at high risk of developing breast cancer should have an annual breast MRI exam in addition to the annual mammograms.  This helps with detecting the breast cancer earlier when the chances of survival are greatest.  MRI can detect cancer that may have been missed by mammography.

 

                                              

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                                                      MRI of the Breast with a Lesion

 

MRI use a very powerful magnetic field and radio waves to create the images of the breast.  The MRI consists of a large tube shaped or cylindrical magnet.  To begin the MRI exam, the patient is positioned on a special table inside the MRI system opening where a magnetic field is created by the magnet.

 

 

 

MRI Exam consists of the following:

  • Series of 2 to 6 sequences with each sequence lasting between 2 to 15 minutes.

  • MRI Sequence is an acquisition of data that produces a specific image orientation and a specific type of image appearance or “contrast”. 

  • Radio signal is turned on and off with the energy being absorbed by different atoms in the body is echoed or reflected back out of the body.

  • These “echoes” are measured by the MRI scanner

  • A digital computer reconstructs these echoes into images of the breast.

  • The tapping noise that is heard during the MRI is created when “gradient coils” are switched on and off to measure the MRI signal reflecting back out of the patient’s body.

  • Contrast – Gadolinium DTPA is a contrast material which is injected into a vein in the arm during the MRI to improve the quality of the images.  This is injected either before the exam or during the actual procedure.  This contrast agent helps produce stronger and clearer images and "highlight" any abnormalities.

  • MRI exam of the breasts takes between 30 – 60 minutes

 

A MRI can show if a cancer is multi-focal (small tumors are present in several areas of the breast).  Determining the extent of the breast cancer with MRI can help determine what treatment is indicated for the patient.  Lumpectomy is the breast conserving surgery and Mastectomy is complete removal of the breast.  Normally mastectomy is indicated if the patient has been diagnosed with multiple tumors in the breast.

 

                                    

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                MRI of Patient with Breast Implants           MRI of Patient with a Breast Lesion

 

 

 

Magnetic Resonance Imaging Benefits

  • Effective with imaging breast implants and ruptures

  • Highly sensitive to small abnormalities

  • Effective in dense breasts

  • Evaluates inverted nipples for evidence of cancer

  • Evaluates the extent of breast cancer

  • Determine what type of surgery is indicated (lumpectomy or mastectomy)

  • Detect breast cancer recurrences and residual tumors after lumpectomy

  • Locate primary tumor in women whose cancer has spread to axillary (armpit) lymph nodes

  • Spot or characterize small abnormalities missed by mammography

  • Useful in screening women at high risk for breast cancer, according to recent studies

                                        

 

 

                                            

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                                  Colorized MRI of the Breast showing a Breast Lesion

                       

 

 

 

Magnetic Resonance Imaging Drawbacks

  • MRI cannot always distinguished between cancerous and non-cancerous abnormalities; which can lead to unnecessary breast biopsies.

  • Unable to image calcifications effectively; tiny calcium deposits can indicate breast cancer. However, MRI is improving in this area.  Mammograms are more reliable with finding calcifications, which are associated with early stage breast cancer.

  • MRI is an expensive exam

  • MRI takes longer to perform than a mammogram

  • Patients need to lie still in a face down position during the exam

  • Patients must be able to tolerate claustrophobia (fear of small spaces)

  • Contrast agent is given by IV to improve image quality

  • MRI is not widely available as mammography

 

 

 

 

 

 

                           

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PET Scan or Positive Emission Tomography is used to find more aggressive growths.  PET Scans detects breast cancer tumors by determining sugar absorption in breast tissue.  Tumor tissue uses more glucose than normal breast tissue.  The PET Scan is effective with gauging the extent of the disease and is used to monitor how much a tumor has shrunk after chemotherapy or radiation treatment.

PET Scans off a type of medical imaging that uses a small amount of a radioactive chemical that is absorbed by specific kinds of body tissue, such as cancer.  The chemical is injected (which is made up of a substance that consists of a combination of a sugar and a small amount of radioactive material) and time is allowed for the chemical to be absorbed.  The patient normally lies still for 45 minutes for the radio-active chemical to circulate within the body.

 

                                         

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                          Positive Emission Tomography - PET Scan with Abnormalities

 

Patients are then placed next to a special set of detectors that can read out the location of the chemical in the body.  The image that results will give information on size and location of the cancer cells.

PET Scans play a role in determining whether a breast mass is cancerous.  These scans are great in finding the larger more aggressive tumors than locating tumors that are smaller than 8 mm and less aggressive. 

PET Scans help with diagnosing cancer when the other imaging techniques show normal results.  These scans are helpful in evaluating and staging cancer that might have come back after remission.  With the staging process, PET Scans are very effective with determining the spread of cancerous cells.  PET Scans has the ability to determine cancer spread more comprehensively and less painfully than other screening procedures and it is effective with detecting biochemical changes in other organs and tissues.

 

 

 

Pet Scan Disadvantages:

  • Pet Scans have been known to give a false positive reading in regarding to breast cancer. 

  • They are expensive and only available in certain diagnostic centers. 

  • The PET Scans require a technician that is highly experienced in training.