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Choi, Kang, and Jung: Breast Magnetic Resonance Image (MRI) Guideline: Breast Imaging Study Group of Korean Society of Magnetic Resonance in Medicine Recommendations
Review Article

iMRI 2018;22(4):205-208.

Published online: 10 January 2018

DOI: https://doi.org/10.13104/imri.2018.22.4.205

Breast Magnetic Resonance Image (MRI) Guideline: Breast Imaging Study Group of Korean Society of Magnetic Resonance in Medicine Recommendations

Seon Hyeong Choi1, Bong Joo Kang2, Seung Eun Jung2

1Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

2Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Bong Joo Kang, M.D. Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel. +82-2-2258-6253 Fax. +82-2-599-6771 E-mail: lionmain@catholic.ac.kr

Received 16 August 2018       Revised 27 August 2018       Accepted 5 September 2018

Copyright © 2018 Korean Society of Magnetic Resonance in Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study is to establish an appropriate protocol for breast magnetic resonance imaging (MRI) in the discipline of image quality standards. The intention of the protocol is to increase effectiveness of medical image information exchange involved in construction, activation, and exchange of clinical information for healthcare.

Keywords: Breast, Magnetic resonance imaging, Guideline

References

1. June SE. CT examination and retest Guidelines. Korean Society of Radiology;2013.
2. Americal College of Radiology (ACR) Accreditation Breast MRI. Available at:. https://www.acr.org/Quality-Safety/Accreditation/BreastMRI. Accessed November 2,. 2018.
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Table 1.
Breast MRI Recommended Protocol Summary
Indication
– Preoperative stage determination after diagnosis of breast cancer/Breast cancer staging before treatment planning
– Evaluation of response to neoadjuvant chemotherapy
– Screening test of high-risk group including BRCA mutation carrier
– Patients with breast augmentation or reconstruction
– If foreign substances injected into the parenchyma are not available for examination other than MRI
– Occult primary breast cancer
– Other follow-up of lesions found in breast MRI
Machine and patient's position
– Obtain images of both breasts while patient is in a prone position using a breast dedicated coil in devices with more than 1.5T
Imaging plane
– The image plane can be obtained by a radiologist, who is comfortable with reading, but both breasts should be included, and the scan range must have no missing areas.
Pulse sequence (must include at least 4 of the following pulse sequences)
– T2-weighted images
– Three or more T1-weighted images (pre-enhancement, early-enhancement, and second-enhancement)
Considerations when evaluating imaging quality
– Water content should be well separated in T2-weighted images
– Contrast enhanced T1-weighted images should be taken by fat suppression technique or should include subtraction images
– Contrast-enhanced T1-weighted images should include images taken between 60 and 120 seconds after contrast injection and images taken after 4 minutes
– The slice thickness of contrast enhanced T1-weighted images should be less than 3 mm and should not have gaps
– The spatial inplane resolution of contrast enhanced T1-weighted images should be less than 1 mm2, should be less than 1.5 mm2
– Temporal resolution of contrast enhanced T1-weighted images should be less than 120 seconds
Table 2.
Options for Further Image Interpretation
1. Both breasts and chest walls are examined with a breast-specific bilateral breast coil. In the prone position, the raised breast is positioned well in the center of the breast coil, and both arms are raised sufficiently to incorporate the axilla into the breast coil as much as possible.
2. The most appropriate examination period is from 7 to 14 days in the menstrual cycle.
3. Immediately after intravenous injection of 0.1–0.15 mmol/kg of contrast medium, the image is repeated several times for the shortest time and with the thinnest slice (3 mm or less).
4. Diffusion weighted image (at high b value = 750–1000)
5. Axilla sequence (sufficient field of view [FOV] is included enough to include neck ∼ nipple)
6. Reconstruction images are obtained with sagittal MPR (without subtraction) and MIP image (with subtraction) using dynamic contrast enhanced T1WI in the early phase (90 seconds after contrast injection).
7. For breast silicone implants, add a silicone selective sequence.
8. Interpretation and determination through the breast MRI part in ACR-BIRADS.
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