MRI Breast
Indications for Breast MRI scan
- Identified mass with indeterminate characteristics following mammography or sonography where patient wishes to avoid biopsy
- Staging for chest wall invasion or lymphadenopathy after cancer diagnosis
- Dense breasts with difficult to read mammogram based on visualisation
- Palpable mass with negative mammography/sonography
- Axillary node metastases with unknown primary
- Unexplained swollen breast or breast implant
- To check the response to neoadjuvant chemotherapy
- To check the extent of infiltrating lobular or ductal carcinoma
- To check residual disease post-lumpectomy
- Postoperative tissue reconstruction
- Dense breasts in the high risk patient
- For MR guided biopsy
- Surveillance of high-risk patients
- Contralateral breast screening
- Determine extent of disease
- Recurrence of breast cancer
- Lesion characterisation
Contraindications for Breast MRI scan
- Any electrically, magnetically or mechanically activated implant (e.g. cardiac pacemaker, insulin pump biostimulator, neurostimulator, cochlear implant, and hearing aids)
- Intracranial aneurysm clips (unless made of titanium)
- Pregnancy (risk vs benefit ratio to be assessed)
- Ferromagnetic surgical clips or staples
- Metallic foreign body in the eye
- Metal shrapnel or bullet
Patient preparation for breast MRI scan
- A satisfactory written consent form must be taken from the patient before entering the scanner room
- Please ask the patient to change into a hospital gown that opens at the front. It is important to ensure that the gown is worn correctly as the patient will be lying face down with the gown open in order to position the breast in the coil.
- Ask the patient to remove all metal objects including keys, coins, wallet, any cards with magnetic strips, jewellery, hearing aid and hairpins
- If possible offer a chaperone to accompany claustrophobic patients into the scanner room (e.g. relative or staff )
- An intravenous line must be placed with extension tubing extending out of the magnetic bore
- Contrast injection risk and benefits must be explained to the patient before the scan.
- Gadolinium should only be given to the patient if GFR is > 30
- Offer earplugs or headphones, possibly with music for extra comfort
- Properly explain the procedure to the patient
- Instruct the patient to keep still
- Note the weight of the patient
Positioning for breast MRI scan
- Head first prone
- Position the patient with breasts inside the breast coil and both arms by the sides of the body (be careful not to dislodge the intravenous line while positioning the patient)
- Give cushions under the legs and under the forehead for extra comfort
- Centre the laser beam localizer over the mid chest (T6-T7 level)
Recommended MRI Breast Protocols, Parameters, and Planning
breast MRI localiser
A three-plane localizer must be taken to plan the sequences. Localizers are normally less than 25 seconds and consist of T1-weighted low-resolution scans.
T2 SPACE axial 3D 1.5mm
Plan the axial slices on the sagittal plane and align the position block parallel to the breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, parallel to the right and left nipples. The slices should be sufficient to cover the entire breast. To prevent wrap-around artifacts, oversampling of both the slice and phase should be applied. Phase direction in the axial scans must be right to left, this is to avoid the artefacts from chest and heart motion.
If 3D sequences are unavailable on your scanner, please utilize 2D T2 axial scans with a slice thickness of 2 to 3mm.
Parameters T2 SPACE 3D
TR 1500-2000 | TE 94 | FLIP 170 | NXA 1.4 | SLICE 1.5 MM | MATRIX 320X256 | FOV 350-390 | PHASE R>L | GAP 10% | OVERSAMPLE 10% and 20% |
Parameters T2 TSE
TR 4000-5000 | TE 110 | FLIP 130 | NXA 2 | SLICE 3 MM | MATRIX 320X320 | FOV 350-390 | PHASE R>L | GAP 10% | OVERSAMPLE 20% |
T1 flash 3D axial non fat sat 1mm
Plan the axial slices on the sagittal plane and align the position block parallel to the breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, parallel to the right and left nipples. The slices should be sufficient to cover the entire breast. To prevent wrap-around artifacts, oversampling of both the slice and phase should be applied. Phase direction in the axial scans must be right to left, this is to avoid the artefacts from chest and heart motion.
Parameters
TR 6-7 | TE 3-4 | FLIP 20 | NEX 1 | SLICE 1MM | MATRIX 384X320 | FOV 350 | PHASE R>L | OVERSAMPLE 30% | IPAT ON |
DWI zoomit \ epi 3 scan trace axial
Plan the axial slices on the sagittal plane and align the position block parallel to the breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, parallel to the right and left nipples. The slices should be sufficient to cover the entire breast. For axial DWI zoomit scans, the phase direction should be from anterior to posterior. This helps avoid artifacts caused by the air-tissue interface by minimizing unwanted areas within the field of view (FOV). To mitigate wrap-around and motion artifacts originating from the chest and heart, it is recommended to apply two saturation bands over the chest region.
Parameters EPI DWI
TR 5000-6000 | TE 90 | IPAT ON | NEX 4 | SLICE 4MM | MATRIX 192X192 | FOV 320-360 | PHASE R>L | GAP 10% | B VALUE 0 |
Zoomit DWI For Breast imaging
Zoomit DWI is an advanced MRI imaging technique that leverages Siemens’ TimTX TrueShape platform and the application called Syngo ZOOMit. TimTX TrueShape introduces a new transmit platform with two independent transmitters, enabling flexible switching of RF waveforms and gradient shapes. This dynamic parallel transmission (pTX) capability opens up new possibilities for imaging applications.
Syngo ZOOMit, the first application based on TimTX TrueShape, utilizes the concept of “zooming” in MR imaging. Similar to optical zoom in a camera, ZOOMit allows for exciting a smaller field-of-view (FOV) than the object in the phase-encoding direction, thereby avoiding aliasing artifacts. By reducing the FOV, fewer phase-encoding lines are required, leading to faster scan times, improved spatial resolution in the region of interest, and reduced motion and flow artifacts.
Zoomit DWI offers several advantages over conventional DWI techniques. It employs multiple parallel radiofrequency pulse sequences simultaneously, capturing high signal specifically from the area of interest. This approach reduces folding artifacts, provides better anatomical detail, decreases distortion and blurring, and improves overall image quality. Additionally, it allows for faster screening, increased spatial resolution, and minimized susceptibility artifacts and geometric distortions.
With ZOOMit, radiologists and researchers can selectively image the volume of interest, achieve faster and higher-resolution imaging, enhance diagnostic confidence by detecting and evaluating smaller lesions in challenging areas, and broaden the scope of clinical MR imaging.
T1 flash axial 3D fat sat dynamic 1 pre and 5 post
Plan the axial slices on the sagittal plane and align the position block parallel to the breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, parallel to the right and left nipples. The slices should be sufficient to cover the entire breast. To prevent wrap-around artifacts, oversampling of both the slice and phase should be applied. Phase direction in the axial scans must be right to left, this is to avoid the artefacts from chest and heart motion.
A dynamic flash 3D fat saturation sequence comprises six flash 1mm 3D scans with a 10-second delay between the first and second scans. The first scan in the dynamic sequence serves as a pre-contrast scan, which is utilized as a subtraction mask for the post-contrast scans. The second through sixth scans are considered post-contrast scans. According to the manufacturer’s instructions and departmental policy, a gadolinium-based contrast agent should be injected at a dose of 0.2ml/kg between the first and second scans, specifically during the 10-second delay period.
Parameters
| TR 4-5 | TE 2-3 | FAT SAT SPAIR | NEX 1 | SLICE 1 MM | MATRIX 448X320 | FOV 350-380 | PHASE R>L | DYNAMIC 6 SCANS | IPAT ON |
What is the reason for performing breast scans using the dynamic contrast-enhanced method?
Dynamic contrast-enhanced MRI (DCE-MRI) helps in the detection and characterization of breast lesions, especially in cases where mammography or ultrasound may not provide sufficient information. By tracking the contrast agent’s uptake and washout over a series of sequential images, DCE-MRI can help differentiate between benign and malignant lesions, assess tumor size, determine the extent of disease, and evaluate treatment response.
During the scan, multiple sets of images are acquired at different time points after the contrast injection, typically in the arterial, venous, and delayed phases. These images capture the contrast agent as it circulates through the blood vessels, allowing radiologists to observe patterns of enhancement and identify areas of abnormal vascularity associated with tumors or other breast abnormalities.
T1 flash coronal 3D fat sat post contrast .7mm
Plan the coronal slices on the axial plane and position the block perpendicular to the right and left breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the sagittal plane, perpendicular to the right and left breast. The slices should adequately cover the entire breast from the nipple to the axilla. In axial scans, the phase direction should be from right to left to avoid artifacts caused by motion from the chest and heart.
Parameters
TR 5-6 | TE 2-3 | FLIP 10 | NEX 2 | SLICE .7MM | MATRIX 512X512 | FOV 350-360 | PHASE R>L | OVERSAMPLE PH 30% and SL 20% | IPAT Off |
T2 tse sagittal RT
Plan the sagittal slices on the axial plane and position the block parallel to the right breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, vertically across the right breast. The slices should sufficiently cover the right breast. In sagittal scans, the phase direction should be from head to feet to avoid artifacts caused by motion from the chest and heart. The field of view (FOV) should be small enough to accommodate just the right breast, typically around 180 to 250mm.
Parameters
TR 3000-4000 | TE 100-120 | SLICE 3MM | FLIP 130-150 | PHASE H>F | MATRIX 288X288 | FOV 180-250 | GAP 10% | NEX(AVRAGE) 2 |
T2 tse sagittal LT
Plan the sagittal slices on the axial plane and position the block parallel to the left breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, vertically across the left breast. The slices should sufficiently cover the left breast. In sagittal scans, the phase direction should be from head to feet to avoid artifacts caused by motion from the chest and heart. The field of view (FOV) should be small enough to accommodate just the left breast, typically around 180 to 250mm.
Parameters
TR 3000-4000 | TE 100-120 | SLICE 3MM | FLIP 130-150 | PHASE H>F | MATRIX 288X288 | FOV 180-250 | GAP 10% | NEX(AVRAGE) 2 |
T1 flash 3d .7mm SFOV bilateral
Plan the sagittal slices on the axial plane and position the right block parallel to the right breast and the left block parallel to the left breast. Verify the positioning block in the other two planes. Ensure an appropriate angle is set in the coronal plane, running vertically across the right and left breast. The slices should adequately cover both the left and right breasts. In sagittal scans, the phase direction should be from head to feet to minimize artifacts caused by motion from the chest and heart. The field of view (FOV) should be small enough to accommodate just the left breast, typically ranging from 180 to 250mm.
Parameters
TR 5.5 | TE 2.14 | SLICE .7MM | FS SPAIR | PHASE H>F | MATRIX 288X288 | FOV 180-250 | OVERSAMPLE SL 20% and PH 100% | NEX(AVRAGE) 1 |
