3T breast MRI is twice as good!
we are committed to doing the finest MRI in Delaware.  We have the only 3T scanner for breast MRI in Delaware since 2007 which means we have more experience.  Actually Dr Chao has done breast MRI in Delaware since 1990.  3T MRI is 100% sensitive for breast cancer.  In three patients in 2007 alone we found additional satellites of tumor which would not have been found which werre missed by mammography or sonography.  The detection of cancer is improved at 3T and is clearly better than 1.5T scanners.  Also you MUST ask about the contrast your provider uses.  We use Prohance which has never (alone) been associated with NSF - nephrogenic systemic sclerosis.  No other provider in Delaware uses the safest MRI contrast.  It is all about our committment to our patients!  The breast MRIs are done with the safest contrast concept and with bettter more detailed pictures.   At 1.5T we have a wide open bore 70cm Espree (weight limit 550lbs) and we use Multihance at 1/2 dose.  Both contrasts we use are the safest for each field strength.  In 2010 a presentation from Italian radiologists suggested that breast MRI should be used on all patients who present with breast cancer as 20% of patients had a treatment change and up to 33% had additional unknown lesions found.   Any procedure which can change patient mangement for as little as 700 dollars out of pocket is a very reasonable test.

MRI Consultants LLC

Our unique service has established our FIRST place in Delaware.  We have the best OPEN and closed MRI scanners in Delaware.  We had the first 3T MRI in Delaware installed in February 2007.  We have had over 6 years experience in the operation of the most complex MRI system in Delaware and can do incredible imaging studies and adapt the study to the patient.   We scan with more detail if patients can hold still and we scan super fast if the patients are anxious or claustrophobic.  Almost any patient can be done in a few minutes of scan time.  We suggest limited each scan to only one body part.  This makes your scan easier to tolerate and shorter.  At 3T the scans can be as little as 1 mintute per scan.

1 Centurian Drive, Ste 107, Newark DE 19713 in the Abby Medical Center.  302-295-3367, 302-999-9897 fax

If you want more articles and images which show you the incredible detail of our MRI studies then please send an email to:

 M R I P H Y S I C I A N at YAHOO  dot C O M

Fom the national insitutes of health....on BREAST MRI - from a presentation at the SMRM in 2006

Diagnostic utility of breast MRI

There is broad published evidence suggesting that breast MR imaging is the imaging

technique that offers highest sensitivity for diagnosing primary and recurrent breast cancer.

Very much unlike mammography, the technique´s sensitivity is not impaired by dense breast

tissue or by therapeutic interventions (postsurgical scars, radiotherapy-induced fibrosis).

With current state-of-the-art MR scanners, sensitivity for invasive breast cancers is virtually

100%. A non-enhancing breast cancer is such a rare finding that it is still worth a case report.

Sensitivity for intraductal cancer (DCIS) is lower, presumably owing to the inconsistent

angiogenic activity of pre-invasive cancer that translates into a inconsistent enhancement

pattern. Still, with adequate diagnostic criteria, sensitivity for DCIS will be about 90-94%.

Current data suggests that regarding DCIS, breast MRI and mammography are

complimentary: mammography helps detect the 10% of DCIS that do not enhance on MRI,

and in turn, MRI helps detect additional DCIS that are mammographically occult owing to the

absence of microcalcifications (8). (Actually new paper from Kuhl 2007 - changes this.)

Specificity of breast MRI (or, specificity of any given breast imaging test) depends on the

composition of the study cohort, of the imaging techniques and diagnostic guidelines that are

used, and, most notably, on the expertise of the interpreting physician. Owing to the wealth of

diagnostic information provided by breast MRI (tissue relaxation times, enhancement

kinetics, cross-sectional morphology, and so forth), specificity is high in experienced hands;

in our department, it is 86% in screening settings. This is substantially higher compared to the

specificity of mammography, and again significantly higher than the specificity of high

frequency breast ultrasound, with or without echo contrast agents. The downside to breast

MRI is the fact that it is still the second most expensive breast imaging modality (after PET),

that the scanner capacity for breast MRI is limited, and, most importantly, that there are only

few trained radiologists with expertise in breast MRI. Based on these facts, the following

statements can be made regarding the clinical use of this technology (9):

Current and emerging indications for using breast MRI in clinical practice

Given the superior sensitivity and overall diagnostic accuracy, the “added value” of breast

MR in current clinical practice is to avoid unnecessary biopsies (and associated costs!)

secondary to false-positive mammographic or sonographic diagnoses, and to improve the

detection and staging of primary and recurrent breast cancer. The latter should translate into

less invasive (and, thus, less expensive!) therapies, lower morbidity and, hopefully, improved

survival. Currently, most of the indications in clinical settings suggest the use of breast MRI

as a “second line” imaging modality, i.e. only after a suspicious or equivocal finding was

made on a mammogram or breast ultrasound (11-17). Two different clinical scenarios are

typical: In the setting of clinical findings, MRI can be used to decide upon whether or not a tissue diagnosis (biopsy) is

actually necessary. In patients with mammographically or sonographically

definitively malignant  are candidates for breast conservation therapy, MRI is indicated to improve local staging: It is

well established that in up to 26% of patients with a presumably solitary cancer, MRI detects

additional, mammographically and sonographically occult cancers in the same or the

contralateral breast. In about 16%, the multicentric or contralateral cancers detected by preoperative

MRI mandate an entire change of surgical or therapeutic approach. A recent large

cohort follow-up study compared mid-term cancer recurrence rates after breast conservation

therapy (including radiotherapy) in women who were staged with pre-operative breast MRI to

the recurrence rates in women who were staged with mammography and high-frequency

breast ultrasound alone. In women who were treated with compared to those treated without

MRI staging, recurrence rates were reduced from over 6% to under 1%. In addition, MRI is
substantially superior compared to mammography or breast ultrasound regarding the
assessment of disease extent: nipple invasion, chest wall invasion, multicentric cancer, and
extensive intraductal component are all contra-indications for breast conservation and are all
best visualized by MRI. With increasing evidence regarding the superior diagnostic accuracy of MRI compared to
conventional imaging methods, there are currently several international large-scale trials
underway to evaluate the use of MRI as a first line imaging modality (18-22). This concept is
increasingly supported because, in spite of the higher direct costs of MRI compared to
conventional methods, it may not be sensible to have the less sensitive imaging methods
(mammography, breast ultrasound) serve as gatekeeper for the method with higher sensitivity.
This possible paradigm shift is in concordance with the concept to individualize screening
efforts in that not all women are subjected to the same protocol (yearly mammographic
screening starting age 40), but to tailor screening efforts to the individual risk profile, i.e.
offering intensified screening protocols – possibly including MRI – to women who carry an
increased risk. An increased risk for breast cancer harbor women who were already diagnosed
with breast cancer (high risk of recurrent ipsilateral or synchronous or metachronous
contralateral breast cancer), women with a history of borderline tissue diagnosis (“lobular
carcinoma in-situ, LCIS”, “atypical ductal hyperplasia, ADH” or “radial scars”), women with
a strong family history for breast cancer (in particular early-onset breast cancer), and women
with presumed or proven mutation in one of the breast cancer susceptibility genes (resulting
in a condition called “hereditary” or “familial” breast cancer). The latter two groups are the
so-called “high risk” subjects; for gene carriers, the individual lifetime risk is as high as 85%-
90% (BRCA1-carriers). The first trial on using MRI screening in high risk women suggests
that MRI helps double the number of cancers detected compared to conventional breast

imaging (sensitivity 100% by MRI compared to 44% for mammography and breast
ultrasound), and with even increased PPV (64% compared to 34%). Further trials confirmed
these encouraging results, consolidating MRI as the new “gold standard” for breast imaging.
For optimum clinical results, breast MRI should be performed with very high spatial and
temporal resolution. There are a few emerging techniques that may help with this task: New
image acquisition strategies (parallel imaging), High-field MRI (3T and higher) and new
contrast agents (Gadomer) may improve our ability to meet these requirements.
Parallel imaging like “SENSE” (SENsitivity Encoding) is a new approach to MR image
acquisition. The gain in image acquisition speed can be invested to improve spatial resolution
at a given acquisition time, or to improve temoral resolution with high matrix imaging. While
SENSE imaging is fully integrated into routine clinical practice for many body and MRA
applications, its use in breast MR is lagging behind. The one reason for this is that owing to
the reduced number of phase encoding steps, using SENSE will go along with an SNR
reduction by about 30%. With the single-acquisition, high-matrix dynamic imaging technique
that is required for breast MR, the resulting in borderline SNR. An ideal combination will be
to do SENSE with high field MR. Magnets operating at 3T and higher become increasingly
available in clinical settings. With the inherently increased SNR brought about by high field
systems, SENSE can be used to acquire high-SNR, high spatial resolution images in a
temporal resolution that ensures “arterial phase” lesion contrast. Another approach to solve
the “temporal-versus-spatial dilemma” is to use contrast agents that are less rapidly diffusable
compared to the small Gd chelates that are in use today. One of the promising candidates for
this purpose is the blood pool agent Gadomer. Originally designed as new contrast agent for
MR angiography (e.g., coronary angiography), it has been shown that it provides an “arterial
phase” type of lesion-to-parenchma contrast not only for 2 minutes, but for a period of about
30 to 45 minutes. This would allow one to take time for very high spatial resolution imaging.
The resulting gadomer-enhanced MR images reveal cross-sectional views through breast
cancers with unprecedented anatomic detail – it is to be expected that this will help further
improve the PPV of breast MRI.
Owing to the wealth of diagnostic information provided by breast MRI (tissue relaxation
times, enhancement kinetics, cross-sectional morphology), specificity is actually high (but, as
always, this requires adequate expertise with the technique); in our department, it is 86% in
screening settings. The downside to breast MRI is the fact that it is still the second most
expensive breast imaging modality (after PET), that the scanner capacity for breast MRI is
limited, and, most importantly, that there are not enough trained radiologists. Given the
superior sensitivity and overall diagnostic accuracy, the “added value” of breast MR in
current clinical practice is to improve the detection and staging of primary and recurrent
breast cancer. The latter should translate into less invasive (and, thus, less expensive!)
therapies, lower morbidity and, hopefully, improved survival.
References:
1. Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK
(eds). SEER Cancer Statistics Review, 1973-1999, National Cancer Institute.
Bethesda, MD, http://seer.cancer.gov/csr/1973_1999/, 2002
2. Jackson VP Screening mammography: controversies and headlines. Radiology 2002
Nov;225(2):323-6
3. Smart CR, Hendrick RE, Rutledge JH III, et al. Benefit of mammography
screening in women ages 40 to 49. Cancer 1195; 75:1619-26
4. Tabar L, Duffy S, Vitak B, et al. The natural history of breast carcinoma. What have
we learned from screening? Cancer 1999; 86:449-62

http://www.smmmc.org/clinicalservices/radiology/3T/
http://www.nhlbi.nih.gov/health/dci/Diseases/mri/mri_during.html

www.appliedradiology.com/Issues/2009/03/Articles/Breast-MRI-at-3T.aspx