Magnetic resonance imaging in breast cancer: A literature review and future perspectives

Abstract

Early detection and diagnosis of breast cancer are essential for successful treatment. Currently mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities and breast magnetic resonance imaging (MRI) has become increasingly important in the detection and delineation of breast cancer in daily practice. However, the clinical benefits of the use of pre-operative MRI in women with newly diagnosed breast cancer is still a matter of debate. The main additional diagnostic value of MRI relies on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional assessment (particularly in patients diagnosed with invasive lobular carcinoma), assessing the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer in patients presenting with cancer metastasis in axillary lymph nodes, among others. Nevertheless, the development of new MRI technologies such as diffusion-weighted imaging, proton spectroscopy and higher field strength 7.0 T imaging offer a new perspective in providing additional information in breast abnormalities. We conducted an expert literature review on the value of breast MRI in diagnosing and staging breast cancer, as well as the future potentials of new MRI technologies.

Keywords: 7.0 Tesla; Breast magnetic resonance imaging; Cancer; Diffusion-weighted imaging; Spectroscopy.

Figure 1

Magnetic resonance imaging scanner with closed bore magnet and a dedicated 8 channel phased-array breast coil (top right). Technically any magnetic resonance imaging scanner could be used in breast image acquisition. However, in daily practice, field strengths of 1.5 T and 3 T are often used due to higher spatial resolution at similar temporal resolution, providing better diagnostic efficacy.

Figure 2

A 48-year-old woman, with positive family history for breast cancer, presented with a palpable lump on the left breast, finally diagnosed as invasive ductolobular carcinoma. A: Sagittal contrast-enhanced fat-suppressed T1-weighted gradient echo images obtained at 3 T shows a spiculated mass, with rim enhancement and small satellite lesion (multifocal disease); B and C: Color parametric enhancement map in axial postcontrast maximum intensity projection and sagittal projection indicates predominantly a plateau enhancement behavior, with some areas of washout.

Figure 3

A 62-year-old patient with nipple withdrawal, finally diagnosed as ductolobular carcinoma. A, B and C: Axial T1-weighted gradient-echo images obtained at 7 T before and after contrast injection. An irregular mass with spiculated margins can be observed on pré-contrast imaging (A). An intense homogeneous enhancement (B) and a rapid wash-out kinetic curve (D) can be observed following contrast administration. In Figure 3C, an ultra-high-resolution T1-weighted gradient-echo sequence with fat suppression was performed, and the morphological aspects of the lesion can be more clearly seen.