A preliminary study of the combination of ultrafast and abbreviated dynamic contrast: Enhanced breast magnetic resonance imaging

Ultrafast Breast MRI: A Narrative Review

Breast magnetic resonance imaging (MRI) is considered the most effective method for detecting breast cancer due to its high sensitivity. Yet multiple factors limit its widespread use, including high direct and indirect costs, a prolonged acquisition time with consequent patient discomfort, and a lack of trained radiologists. During the last decade, new strategies have been followed to increase the availability of breast MRI, including the omission of non-essential sequences to generate abbreviated MRI protocols (AB-MRIs) aimed at reducing the acquisition time with the potential of improving the patient's experience and accommodating a higher number of MRI examinations per day. An alternative method is ultrafast MRI (UF-MRI), a novel technique that gathers kinetic data within the first minute after contrast injection, offering high temporal resolution. This enables the analysis of early contrast wash-in curves, showing promising outcomes. In this study, we reviewed the role of UF-MRI in breast imaging and detailed how the integration of this new approach with radiomics and mathematical models might further improve diagnostic accuracy and even have a prognostic role, a fundamental characteristic in the modern scenarios of personalized medicine. In addition, possible clinical applications and advantages of UF-MRI will be discussed.

Clinical role of abbreviated and ultrafast MRI in breast imaging

Current breast cancer screening relies on mammography, digital breast tomosynthesis and breast ultrasound. In select populations, breast MRI is also of great utility. However, multiple factors limit widespread use of breast MRI for screening. Efforts have been made to increase the availability of breast MRI for screening, in large part due to the increased cancer detection rate of breast MRI compared to mammography. Techniques include shortening standard breast MRI protocols with the potential for accommodating MRI screening in a higher number of patients. This review will explain the role of abbreviated breast MRI and ultrafast breast MRI in breast imaging, and detail how these approaches differ from standard dynamic contrast-enhanced breast MRI. In addition, limitations and advantages of these techniques will also be discussed.

Ultrafast Dynamic Contrast-Enhanced MRI of the Breast: From Theory to Practice

The development of ultrafast dynamic contrast-enhanced (UF-DCE) MRI has occurred in tandem with fast MRI scan techniques, particularly view-sharing and compressed sensing. Understanding the strengths of each technique and optimizing the relevant parameters are essential to their implementation. UF-DCE MRI has now shifted from research protocols to becoming a part of clinical scan protocols for breast cancer. UF-DCE MRI is expected to compensate for the low specificity of abbreviated MRI by adding kinetic information from the upslope of the time-intensity curve. Because kinetic information from UF-DCE MRI is obtained from the shape and timing of the initial upslope, various new kinetic parameters have been proposed. These parameters may be associated with receptor status or prognostic markers for breast cancer. In addition to the diagnosis of malignant lesions, more emphasis has been placed on predicting and evaluating treatment response because hyper-vascularity is linked to the aggressiveness of breast cancers. In clinical practice, it is important to note that breast lesion images obtained from UF-DCE MRI are slightly different from those obtained by conventional DCE MRI in terms of morphology. A major benefit of using UF-DCE MRI is avoidance of the marked or moderate background parenchymal enhancement (BPE) that can obscure the target enhancing lesions. BPE is less prominent in the earlier phases of UF-DCE MRI, which offers better lesion-to-noise contrast. The excellent contrast of early-enhancing vessels provides a key to understanding the detailed pathological structure of tumor-associated vessels. UF-DCE MRI is normally accompanied by a large volume of image data for which automated/artificial intelligence-based processing is expected to be useful. In this review, both the theoretical and practical aspects of UF-DCE MRI are summarized. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.

Breast MRI - The champion in the millimeter league: MIO breast MRI - The method of choice in women with dense breasts

We perform MRI of the breast as a first pass technique. We successfully established 10-minute-protocols (including T2 images) with a fixed dosage of 5 ml 1 M CM. A high spatial resolution of 526 × 526, better 672 × 672 or maximum (1.024 × 1.024, MIO MRI) is vital to achieve best results. We use fixation tools to avoid motion artifacts. Motion correction algorithms can, however, often eliminate such artifacts when they are present. In initial breast MRI exams, morphologic features are the most important criteria for lesion evaluation. If previous exams are available for comparison, the main criteria indicating a suspicious lesion are an increase in lesion size or the depiction of new lesions. High quality HR MRI of the breast is the method of choice in women with dense or extremely dense breasts in all cases (screening, assessment, follow up). In density type A or B, MRI can be helpful in defined constellations, e.g. when MX and US are limited or contraindicated. According to our experience, 95% or more of all carcinomas of the breast are detectable on MRI. The remaining 5% of MRI-occult lesions are intraductal tumors or very small invasive carcinomas depicted with mammography due to associated microcalcifications. MRI is, however, superior to all other imaging modalities in the detection of the clinically relevant DCIS (high risk DCIS, intermediate type). Consecutive MRI examinations in intervals of 12 to 24 months allow a reliable detection of invasive breast cancer with an average size of 7-8 mm. This corresponds to a rate of metastasis-free locoregional lymph nodes in >95% of cases. The rate of interval cancers is <2%. In conclusion, this strategy may increase the overall-lifetime survival of breast cancer patients to more than 95%. Inversely, mortality may be reduced to <5%. Taking these improvements in early breast cancer detection and survival that can be achieved through the implementation of QA HR MRI of the breast into account, it should be discussed to modify oncologic guidelines for the treatment of breast cancer. MRI is the best diagnostic tool we have and according to our experience, a first pass, quality-assured high-resolution breast MRI protocol provides best diagnostic results at minimal procedural effort.