jksr Journal of the Korean Society of Radiology J Korean Soc Radiol 1738-2637 2288-2928 The Korean Society of Radiology 10.3348/jksr.2019.80.1.47 jksr-80-47 Review Article Use of Abbreviated Magnetic Breast Cancer Screening Resonance Imaging in LeeSu HyunMD ∗ MoonWoo KyungMD Department of Radiology, Seoul National University Hospital, Seoul, Korea Corresponding author Su Hyun Lee, MD Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel 82-2-2072-1665 Fax 82-2-743-6385 E-mail suhyune82@gmail.com 01 2019 20 01 2019 80 1 47 58 18122018 10012019 16012019 Copyright © 2019 The Korean Society of Radiology 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Magnetic resonance imaging (MRI) is the most sensitive modality used for breast cancer screening, and is known to detect biologically significant cancers and few interval cancers. Application of standard breast MRI examination is not economical for screening due to the high costs associated with long interpretation and reading times. However, abbreviated breast MRI can reduce time and cost while maintaining diagnostic accuracy, and improve cost-effectiveness in breast cancer screening. A multi-center clinical trial on breast cancer screening using abbreviated breast MRI in high-risk women in Korea is being conducted. Another multicenter clinical trial has been conducted in the USA and Europe to investigate the efficacy of abbreviated breast MRI in women with average to intermediate cancer risk. Furthermore, when performed simultaneously with ultrafast MRI, the accuracy of abbreviated breast MRI can be enhanced. However, since abbreviated breast MRI uses contrast agents, it is important to consider the possibility of residual gadolinium in the body.

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Configuration of standard full diagnostic protocol and abbreviated protocol of breast MRI.

Images of a 39-year-old woman with a history of ductal carcinoma in situ in the left breast and no family history of breast or ovarian cancer. (A) Bilateral full-field digital mammography shows postoperative change only in the left inner breast. (B, C) Maximum-intensity projection (B) and first post-contrast T1-weighted images (C) show segmental clumped non-mass enhancement (arrows) in the right outer breast with underlying moderate background parenchymal enhancement. MRI-guided vacuum-assisted biopsy on the right outer breast shows high-grade ductal carcinoma in situ.

Images of a 61-year-old woman with a history of invasive ductal carcinoma in the left breast and no family history of breast or ovariancancer. Maximum-intensity projection (A) and first post-contrast T1-weighted images (B) show a 0.7-cm oval, circumscribed, heterogeneously enhancing mass in the right breast located at the 7 o'clock position with underlying minimal background parenchymal enhancement. The mass is considered benign because of the high sig-nal intensity on T2-weighted image (C) and stability for over 1 year as compared to the preoperative MRI.

Abbreviated Breast MRI Protocols and Acquisition Times in Different Studies

Study/Protocol T1 Precontrast T1 Post-Contrast (First) T1 Post-Contrast (Second) T1 Post-Contrast (Third) T2 STIR Post-Processing Magnet Time (min)
Subtraction MIP
Kuhl et al. (8) V V       V V 3
Mango et al. (11) V V       V V 10–15
Grimm et al. (12)/AP1 V V     V V   11
Grimm et al. (12)/AP2 V V V   V V   13
Harvey et al. (13) V V       V V 4.4
Heacock et al. (14) V V     V V   12
Moschetta et al. (15) V     V V V V V 10
EA1141 trial (16) V V     V V V ≤ 10
Korean Multicenter Study (17) V V     V V V ≤ 10

AP = abbreviated protocol, EA1141 = Eastern Cooperative Oncology Group-American College of Radiology Imaging Network 1141, MIP = maximum-intensity projection, STIR = short inversion time inversion recovery

Performance and Interpretation Time of Abbreviated and Standard Full Diagnostic Breast MR Protocols

Study MRI Indications No. of Cancers Sensitivity (%) Specificity (%) PPV (%) NPV (%) Interpretation Time (sec)
AP FDP AP FDP AP FDP AP FDP AP FDP AP FDP
Kuhl et al. (8) Screening∗ 11 11 100 100 94.3 93.9 24.4 23.4 100 100 28 -
Mango et al. (11) Pre op. & screening† 100 100 96 - - - - - - - 44 -
Grimm et al. (12) Screening† 11 12 86–89 95 45–52 52 - - - - 178.8 177
Grimm et al. (12) Screening† 11 12 86–89 95 45–52 52 - - - - 178.8 177
Harvey et al. (13) Screening† 7 7 - - - - - - - - 93 385.8
Heacock et al. (14) Pre op. & screening† 107 107 97.899.4 - - - - - - - 25 -
Moschetta et al. (15) Pre op. & screening† 67 69 89 92 91 92 64 68 98 98 120 360

Mild-to moderate risk,

High risk. AP = abbreviated protocol, FDP = full diagnostic protocol, NPV = negative predictive value, op. = operative, PPV = positive predictive value