**New, Innovative Breast Imaging Modalities**

**1** 

Marc Lobbes and Carla Boetes *Maastricht University Medical Center* 

*The Netherlands* 

**Magnetic Resonance Imaging of the Breast** 

Magnetic resonance imaging (MRI) of the breast was first performed in the late 1980s. At first, differentiation between benign and malignant breast lesions was primarily based on their differences in T1 and T2 relaxations times (Rausch et al., 2006). Due to the large overlap in T1 and T2 relaxation times in benign and malignant breast lesions, it became apparent that contrast administration was mandatory for reliable breast MRI. Heywang et al. demonstrated that breast carcinomas showed significant enhancement within 5 minutes

Since then, increasing field strengths, dedicated breast coil designs, and improvements in sequence protocols have led to a large improvement in diagnostic accuracy of breast MRI. Currently, the sensitivity of contrast-enhanced MRI for detecting breast cancer reaches 88%, with a specificity of 68%. The positive predictive value is reported to be 72%, with a negative predictive value of 85% (Bluemke et al., 2004). The reported sensitivity and specificity may vary in different publications due to differences in study populations, and technical and diagnostic criteria used. Reported sensitivities therefore vary from 83-100%,

These numbers are superior to mammography and ultrasound, and are independent of factors such as tumor histology, breast density, and hormonal therapy use. They also show that breast MRI is highly accurate for detecting breast cancer. However, due to the rather limited specificity, false-positive results are frequently observed, requiring additional

In this chapter, the technical aspects and proper indications of breast MRI are discussed. In addition, a systematic approach to the image interpretation of breast MRI is proposed.

Before performing breast MRI, it is important to instruct the patient thoroughly. It is important to inform the patient that lying comfortly and motionless is important for succesfull imaging of the breast. They should be instructed that administration of the contrast agent can result in various physical sensations, which may cause patient anxiety

**1. Introduction** 

**2.1 Patient handling** 

(and motion) when not properly instructed.

after contrast administration (Heywang et al., 1989).

with reported specificities varying from 29-100% (Rausch et al., 2006).

**2. Performing magnetic resonance imaging of the breast** 

imaging or (MR guided) biopsy, in turn causing patient anxiety and discomfort.
