Breast MRI
Dynamic contrast-enhanced breast MRI — highest-sensitivity breast imaging modality. Used for high-risk screening (BRCA carriers, strong family history, prior chest radiation), preoperative staging of known cancer, evaluating response to neoadjuvant therapy, and problem-solving indeterminate mammogram/ultrasound findings. Prone positioning in dedicated breast coil.
Clinical pathway
- IV access in arm contralateral to any known pathology.
- Prone positioning in dedicated 7–16 channel breast coil.
- Localizer + T2 — anatomic evaluation, fluid collections, cysts.
- Dynamic contrast series — T1-weighted fat-saturated pre-contrast + 4–6 post-contrast phases (gadolinium, 0.1 mmol/kg).
- Diffusion-weighted imaging — adjunct for lesion characterization.
- Subtraction + MIP reconstructions for reporting.
Typical systems
- Siemens MAGNETOM Vida 3T with dedicated breast coil
- GE Signa family 1.5T/3T
- Philips Ingenia Elition 3T
3T offers higher SNR for sub-centimeter lesions; 1.5T adequate and common in community centers. Dedicated 16-channel breast coils (Sentinelle, others) improve SNR over standard 4–8 channel.
Room + procedure characteristics
- Scan time: 25–40 min typical
- Contrast: gadolinium required — macrocyclic agents preferred (Gadavist, Dotarem, Clariscan)
- Scheduling: premenopausal women day 7–14 of cycle to minimize background parenchymal enhancement
Dose / safety
No ionizing radiation. SAR monitored. Gadolinium contraindicated in severe renal impairment.