MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.

including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. Diagnostic uses of MRI were not considered to be within the scope of this review.

New evidence on breast Magnetic Resonance Imaging (MRI) screening has become available since the American Cancer Society (ACS) last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk. Screening MRI is recommended for women with an approximately 20-25% or greater lifetime risk of breast cancer,including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. Diagnostic uses of MRI were not considered to be within the scope of this review.

No abstract

The aim of breast MRI is to obtain a reliable evaluation of any lesion within the breast. It is currently always used as an adjunct to the standard diagnostic procedures of the breast, i.e., clinical examination, mammography and ultrasound. Whereas the sensitivity of breast MRI is usually very high, specificity—as in all breast imaging modalities—depends on many factors such as reader expertise, use of adequate techniques and composition of the patient cohorts. Since breast MRI will always yield MR-only visible questionable lesions that require an MR-guided intervention for clarification, MRI should only be offered by institutions that can also offer a MRI-guided breast biopsy or that are in close contact with a site that can perform this type of biopsy for them. Radiologists involved in breast imaging should ensure that they have a thorough knowledge of the MRI techniques that are necessary for breast imaging, that they know how to evaluate a breast MRI using the ACR BI-RADS MRI lexicon, and most important, when to perform breast MRI. This manuscript provides guidelines on the current best practice for the use of breast MRI, and the methods to be used, from the European Society of Breast Imaging (EUSOBI).

B r e a s t T u m o rs: C o m p a ra tiv e A c c u ra c y o f MR Im a g in g R elativ e to M a m m o g ra p h y a n d US fo r D e m o n s tra tin g E x te n t1 A PURPOSE; To evaluate the compara tive accuracy of magnetic resonance (MR) imaging relative to mammogra phy and ultrasonography (US) for assessing the extent of breast tumors. MATERIALS A N D METHODS:His tologic results and preoperative im aging findings (mammography, US, MR imaging) were analyzed regard ing tumor size and multifocality of 61 tumors in 60 women undergoing mastectomy for carcinoma. RESULTS:In 10% of cases, the index tumor was not seen at mammogra phy. With US, 15% of the index tu mors were not recognized, while MR imaging missed 2% of the index tu mors. On mammographic and US images, tumor size was underesti mated significantly (P < .005), by 14% and 18%, respectively, while MR im aging showed no significant differ ence in size compared with that found in a pathologic evaluation. Mammography showed 31% of the additional invasive lesions, w hile US showed 38% and MR imaging showed 100%. CONCLUSION: MR imaging was the most accurate of the three preopera tive imaging modalities in assessing the size and number of malignant lesions in the breast.

Gadolinium-enhanced TurboFLASH imaging is a valuable method in the examination of breast lesions suspected of being malignant.

Purpose:The clinical diagnosis and management of invasive lobular carcinoma (ILC) of the breast presents difficulties. Magnetic resonance imaging (MRI) has been proposed as the imaging modality of choice for the evaluation of ILC. Small studies addressing different aspects of MRI in ILC have been presented but no large series to date. To address the usefulness of MRI in the work-up of ILC, we performed a review of the currently published literature. Materials and methods: We performed a literature search using the query ''lobular AND (MRI OR MR OR MRT OR magnetic)'' in the Cochrane library, PubMed and scholar.google.com, to retrieve all articles that dealt with the use of MRI in patients with ILC. We addressed sensitivity, morphologic appearance, correlation with pathology, detection of additional lesions, and impact of MRI on surgery as different endpoints. Whenever possible we performed metaanalysis of the pooled data. Results: Sensitivity is 93.3% and equal to overall sensitivity of MRI for malignancy in the breast. Morphologic appearance is highly heterogeneous and probably heavily influenced by interreader variability. Correlation with pathology ranges from 0.81 to 0.97; overestimation of lesion size occurs but is rare. In 32% of patients, additional ipsilateral lesions are detected and in 7% contralateral lesions are only detected by MRI. Consequently, MRI induces change in surgical management in 28.3% of cases. Conclusion: This analysis indicates MRI to be valuable in the work-up of ILC. It provides additional knowledge that cannot be obtained by conventional imaging modalities which can be helpful in patient treatment.