Breast MRI

Breast MRI imaging technique provides beneficial insights into breath health and used as an additional tool along with other screening methods like mammography and ultrasound.

How necessary is Breast MRI?

As per research globally, there has been the breast cancer risk has increased in women for whom MRI plays a crucial role. At first, the suggestion was to undergo yearly MRI screening only for individuals with a genetic mutation. Further studies indicated that the screening of breast MRI can be recommended as a screening test along with mammogram especially for women with dense breast. Various studies demonstrated the superiority of breast MRI over mammography and ultrasound sonography in providing 89-100% accurate results.

Significance of Breast MRI

Breast MRI provides a valuable approach to breast health. Its significance lies below areas.

• High-risk screening: For women with a high risk of developing breast cancer with predisposing genetic syndromes, MRI can be a crucial tool for early detection, potentially saving lives.
• Cancer evaluation: Following a breast cancer diagnosis, MRI can help assess the staging and severity of the disease and guide treatment decisions, ensuring the best possible outcomes for patients.
• Abnormality assessment: When other imaging tests reveal suspicious findings, MRI can provide further clarification and aid in diagnosis, ensuring accurate and timely interventions.
• Implant assessment: Breast MRI is the most effective method for determining whether silicone breast implants have ruptured, providing essential information for patient care.

Additional benefits:

• Detects small abnormalities not seen with other tests.
• Evaluates the size and location of breast cancer lesions.
• Determines whether lumpectomy or mastectomy is more effective.
• Detects changes in the other breast that has not been diagnosed with cancer.
• Detects the spread of tumor into the chest wall.
• Detects breast cancer recurrence or residual tumour after lumpectomy.
• Evaluates a newly inverted nipple change.

Procedure:

The healthcare provider instructs the following information.

• Remove metallic objects or jewellery.
• Change into a hospital gown.
• Enquire about any health conditions or allergies.

MRI exams are found to be safe for majority of patients with metal implants, excluding few types. Here are some of the considerations to examine the individuals with the following implants for safety before undergoing MRI.

• Individuals with certain cochlear (ear) implants 
• Certain types of metal coils are inserted in blood vessels.
• Those with certain types of metal coils inserted in blood vessels.
• Individuals with older cardiac defibrillators and pacemaker
• Individuals with vagal nerve stimulators

Once the individual is all set to undergo procedure here is what is expected to do.

• Lie face down on a padded table with your arms at your side.
• The table slides into an MRI machine (tunnel-like opening).
• Remain still during the imaging sequences.
• Follow instructions to hold your breath when necessary.
• Expect loud tapping and knocking sounds during imaging.
• Earplugs or earphones may be provided for comfort.
• In a few MRI procedures, an intravenous gadolinium line is given by inserting a small needle into a vein arm . Initially, the saline solution flows through the IV line followed by gadolinium dye. This dye flows through your bloodstream and helps create a clearer picture of your breasts.
• Communicate with the technician via intercom for instructions and support.
• Breasts may feel warm or as if you need to urinate.

Duration: The duration of the procedure for generating each set of images typically requires a few minutes, and the entire test generally lasts between 30 to 45 minutes. Following the test, you might need to wait as the images are reviewed to determine if additional ones are necessary.

For a more recent MRI method called abbreviated breast MRI, fewer images are captured, resulting in a shorter scan duration, usually around 10 minutes.

Aftercare:

• The IV line will be removed (if they are connected)
• Resume normal activities unless sedated.
• A radiologist reviews the images and sends them to your doctor.
• Discuss results with your doctor at a follow-up appointment.

Contraindications and considerations

Breast MRI is not recommended for the following conditions.

Pregnancy: MRIs are generally not recommended during pregnancy, especially in the first trimester, due to potential risks from the contrast dye. Discuss alternative imaging options with your doctor if you are pregnant.

Breastfeeding: Recent studies suggest that stopping breastfeeding may not be necessary after a breast MRI, as the amount of contrast dye in breast milk is minimal. Consult your doctor for specific recommendations regarding breastfeeding after the test.

Allergic reaction: If one has experienced an allergic response to the injectable contrast solution utilized in many breast MRI examinations, the doctor will not recommend MRI. The contrast solution might lead to issues in individuals with kidney or liver complications.

Medical device implants: If you have any implanted medical devices or other metal objects in your body, there may be instances where you are unable to safely undergo an MRI. This is especially true if you have specific types of devices (such as certain breast tissue expanders) or metals in your body.

Interpretation of results

A radiologist interpretates medical images and analyse breast MRI scans. They prepare a detailed report of findings keeping into consideration of medical history and relevant symptoms. This reported will be sent to referred physician for further evaluation or treatment decisions.

Based on the results, additional test or imaging studies, or specific treatment options may be recommended. They will discuss the best course of action based on your individual situation.

Risks

Sedation: Overuse of sedation, though rare, can occur. However, the vital signs will be closely monitored to minimize this risk.

Magnetic field: The magnetic field is harmless to humans but may interfere with implanted medical devices. Inform your doctor about any implants before the test.

Nephrogenic systemic fibrosis: This rare complication is associated with gadolinium contrast and primarily affects patients with severe renal disease. The healthcare provider will assess your kidney function before the test.

Allergic reaction: A slight risk of allergic reaction to the contrast material exists, usually mild and manageable with medications.  

Gadolinium retention: While no known health effects exist, small amounts of gadolinium may remain in the body, particularly the brain, after multiple MRI exams. This is most likely in patients receiving frequent MRIs for chronic conditions. The contrast is mainly eliminated through the kidneys. Consult your doctor about gadolinium retention if you undergo multiple MRIs.

Breastfeeding: After receiving gadolinium contrast, it's recommended to avoid breastfeeding for 24-48 hours. However, recent studies suggest minimal absorption of contrast by infants during breastfeeding.

Conclusion:

Breast MRI is a supplementary imaging technique to diagnose abnormalities of breast, especially in diagnosing breast cancer. Most of the breast MRI are non-invasive, although a few cases require dye injection. It is important to thoroughly discuss with health care providers about medical history and any other implanted surgery done before undergoing a breast MRI procedure.