Feature | March 19, 2013 | By Williette Nyanue

Breast MRI Benefits from Research

This article appeared as an introduction to a Comparison Chart on Breast MRI Systems in the March 2013 issue.

Breast MRI

Photo courtesy of Hitachi Medical Systems America

Increasing research on women with dense breasts is having a positive effect on imaging modalities. It is estimated that between 30–40 percent of women in the United States have dense breasts. Because fatty breast tissue makes it difficult to identify breast tumors on standard mammography exams until very advanced stages, dense breasts are a strong independent factor for breast cancer. Research has shown that it is beneficial for this population of women to invest in additional imaging. 

Due to the strong independent factor for cancer, Connecticut, New York, Texas, California and Virginia have passed legislation requiring radiologists to tell women if they have dense breasts, and to advise them of what additional imaging, besides mammography, is needed for proper diagnosis and effective care. Ten other states also have similar legislation pending, and the U.S. Food and Drug Administration (FDA) has drafted a publication that, when released, will lay out a standard of care. 

Many women are turning to breast magnetic resonance imaging (MRI) for additional screening. MRI is one of the fastest growing imaging modalities because of its image consistency and specificity. According to Christian Geppert, Ph.D., Siemens Medical Solutions research and development collaborations manager at NYU Medical Center, of all the modalities used to perform breast imaging — including automated whole-breast ultrasound and contrast-enhanced mammography — MRI has the highest sensitivity and the widest range of possibilities. And unlike ultrasound, which is a manual process, MRI delivers more consistent results. 

Existing Breast MRI Options

There are a range of MRI systems available across all platforms including 1.5T and 3.0T scanners, plus a variety of accessories. A range of coils is available including very homogeneous, high signal intensity coils and coils capable of doing breast biopsy. While MRI scanners come in many sizes, Geppert said in the United States, many radiologists opt for a wide-bore system (70 cm). This system provides more patient comfort, and a large percentage of people can fit into the scanner, including larger women. 

Imaging Techniques

With simple modifications of the way data is acquired, there are existing technologies for breast MRI that radiologists can use on existing systems. In addition to traditional contrasts, such as T1 or T2 weighting, diffusion-weighted imaging (DWI) is a technique that has become more prevalent. “Diffusion-weighted imaging was first used in stroke patients, but soon radiologists discovered that in tumors, water has restricted diffusion lengths,” said Geppert. The technique was introduced about 10 years ago for breast imaging. He explained that if you apply a sequence that is sensitive to the diffusion (water mobility), you can get an image that is highly sensitive to this kind of cell cluster. DWI gives radiologists a different view to either confirm or negate T1 and T2 weighted images. 

Another technique available for breast MRI, and beneficial to women with dense breasts, is the Dixon technique. This technique allows radiologists to get two sets of images: one with the fat tissue, and one with water and any possible tumors. 

Time Management

Traditional breast MRIs can take from 20–40 minutes, much longer than standard mammograms. Several new, faster MRI technologies have evolved over the last year to decrease exam time. One such technique is the time-resolved angiography with interleaved stochastic trajectories (TWIST) sequence, which Geppert said enables much faster data acquisition in breast imaging and is flexible on how to set the balance between spatial and temporal resolution. The TWIST sequence allows the MRI to acquire the highest spatial resolution, and at the same time see the contrast uptake over time as fast as possible. If the image is captured at the right moment, it will show just the arteries and possible tumors. 

Another way that MRI is increasing in speed is with the use of high channel coils — 16 or even 18 channel diagnostic breast coils. These coils also allow for higher temporal resolution. 

Advances in Reimbursement

For most, breast MRI is expensive, and therefore difficult to get reimbursed. However, this is changing due to the increasing number of women reported to have dense breasts. According to Geppert, “There are a number of settings for which reimbursements are available, for example, high-risk patients and those with dense breasts. Annually, these patients will have both breast MR and mammography, and insurance companies will pay for it.”

Day Optimized Throughput 

Breast MRI exams can also be complicated. But recently the day optimizing throughput (Dot) technology was introduced to make it easier for radiology technologists to perform the breast exam. “Dot technology offers guidance and instructions with images throughout the scanning process. It provides example images and helps guide MR techs through the procedure,” said Geppert. “The Dot engine helps the user to know what they should be looking for and what adjustments need to be made, and ultimately can reduce the number of scans that must be repeated because of such errors.”   itn

Related Content

MRI scanners, helium gas field discovery, Africa, future supply
News | Magnetic Resonance Imaging (MRI) | July 01, 2016
Helium is essential for many modern technologies, including magnetic resonance imaging (MRI) scanners. Now, researchers...
methylene blue, short-term memory, MRI study, University of Texas Health Science Center, Timothy Q. Duong
News | Neuro Imaging | June 30, 2016
A single oral dose of methylene blue results in an increased magnetic resonance imaging (MRI)-based response in brain...
Vital Images, Vitrea 7 advanced visualization software, SCCT 2016
Technology | Advanced Visualization | June 30, 2016
Vital Images Inc. recently launched version 7 of its Vitrea advanced visualization software. This application-based...
Ikonopedia, Frost & Sullivan, 2016 Technology Leadership Award, breast reporting system market
News | Breast Imaging | June 30, 2016
Based on its recent analysis of the breast imaging reporting solutions market, Frost & Sullivan recognized...
Mayo Clinic, compact 3T MRI scanner, prototype, Rochester, GE Healthcare

Image courtesy of Mayo Clinic.

News | Magnetic Resonance Imaging (MRI) | June 29, 2016
This week Mayo Clinic in Rochester, Minn., unveiled a new, one-of-a-kind, compact 3T magnetic resonance imaging (MRI)...
DEFUSE-2 studym, MRI, brain bleeding risk, post-stroke treatment, NIH

This image combines pre- and post-treatment scans from the same patient. Analysis of the two scans revealed that the area and size of post-treatment bleeding corresponded to blood-brain barrier disruption (shown in green, yellow and red) prior to therapy. Image courtesy of Richard Leigh, NINDS.

News | Advanced Visualization | June 29, 2016
In a study of stroke patients, investigators confirmed through magnetic resonance imaging (MRI) brain scans an...
artificial intelligence, breast cancer diagnosis, Beth Israel Deaconess Medical Center, Harvard Medical School
News | Computer-Aided Detection Software | June 28, 2016
Pathologists have been largely diagnosing disease the same way for the past 100 years, by manually reviewing images...
breast MRI, lumpectomy, prone vs supine position, BWH study, Brighm & Women's Hospital
News | MRI Breast | June 27, 2016
A new phase 1 clinical trial from Brigham and Women's Hospital published in Radiology on June 22 evaluated the...
BHF, Reflections of Research image competition, U.K., 4-D MRI, heart blood flow

This image shows blood flow within the main pumping chambers – the ventricles – on both sides of the heart and the vessels leaving the heart. The blue flow is blood that needs oxygen and is travelling to the lungs. The red flow is blood that has been through the lungs and received oxygen. Victoria Stoll of the University of Oxford is using this type of imaging to look at the blood flow within the hearts of people with heart failure, whose hearts are not pumping effectively.

News | Cardiac Imaging | June 24, 2016
The British Heart Foundation (BHF) announced the winners of its annual ‘Reflections of Research’ image competition,...
VASH collimator, DOE, molecular breast imaging, SNMMI 2016

Adding this variable angle slant hole collimator to an existing breast molecular imaging system allows the system to get six times better contrast of cancer lesions in the breast, providing the same or better image quality while also potentially reducing the radiation dose to the patient by half. Technologies developed at DOE’s Jefferson Lab for the variable angle slant hole collimator are included in two filings to the U.S. Patent and Trademark Office. Image courtesy of DOE’s Jefferson Lab.

News | Breast Imaging | June 21, 2016
Preliminary tests have demonstrated that a new device may enable up to six times better contrast of tumors in the...
Overlay Init