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Title

Breast Imaging: The Use of MRI as a Diagnostic Adjunct (0.5 credit hours)

Abstract

Over the years, magnetic resonance (MR) scanners have evolved to be faster and stronger, facilitating rapid 3D acquisitions of contrast-enhanced breast tissue. MR mammography is more sensitive than sonographic imaging of the breast and is capable of detecting lesions not visualized on conventional mammograms. Unfortunately many patients screened with MR mammography have been unnecessarily subjected to biopsy due to its high false positive rate. In young women with dense breasts, enhancing masses, though benign, would require biopsy if found on MR. While very sensitive for malignancy, it is not very specific. MRI has a valuable role in the diagnosis of breast cancer; however, applications of MR mamography should be reserved for patients at high risk. This module discussed the value of MR mammorgaphy as a tool for problem-solving patients with complex mammograms, pre-operative planning, and monitoring therapy in patients with breast cancer. Portions of this module's content are reprinted with permission of AuntMinnie.com. This activity is approved for credit by the ASRT. Course Approval Expiration/End Date: August 1, 2011 Category A Credit.

This activity may be available in multiple formats or from different sponsors. The ARRT does not allow CE activities such as internet courses, home study programs or directed readings to be repeated for CE credit in the same or any subsequent biennium.

Author

Bernadette M. Kaufman, RT(R) (MR)

Bernadette Kaufman’s diagnostic imaging experience spans two decades and crosses multiple modalities. With experience in CT, MRI, mammography, ultrasound and diagnostic radiography, she has authored and presented numerous topics in imaging. She has served on a variety of education-focused committees for ASRT and SMRT and contributes regularly to scholarly journals and text books on diagnostic imaging. Bernadette is currently pursuing her degree in education.

Kathleen Klaas, RN, MD

Dr. Kathleen Kay Klaas began her medical career in Omaha Nebraska as a registered nurse. Her interest in medicine brought her to Creighton University School of Medicine, where she graduated with honors. She completed both her residency in Radiology as well as a fellowship in Women's Imaging at Medical College of Wisconsin Affiliated Hospitals (Milwaukee). Dr. Klaas' passion for women's health and imaging has made breast imaging her primary focus. She holds membership in the Society of Breast Imaging among other Radiology organizations and societies, and currently serves as Director of Breast Imaging at Waukesha Memorial Hospital in Waukesha, Wisconsin.

Objectives

Upon completion of the module the learner should be able to:

Compare and contrast the roles of mammography and MR mammography in both high-risk and low-risk patients.
Identify risk factors for breast cancer.
Identify the four types of kinetic curves.
Describe the seven BI-RADS® Classifications for breast MR findings.

Resources

Bibliography
American College of Radiology (ACR). ACR BI-RADS®--Mammography. 4th Edition. ACR Breast Imaging Reporting and Data System, Breast Imaging Atlas; BI-RADS. Reston, VA. American College of Radiology; 2003.

Hlawatsch A, Titfke A, Schmidt M, Thelen M. Pre-operative assessment of breast cancer; sonography versus MR imaging. AJR. 2002;179:1493-1501. American Cancer Society; 2004.

Humphreys LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2002;137:347-360.

Klaas KK. Radiography and pathology reports (2005). Waukesha Memorial Hospital and Oconomowoc Memorial Hospital, Wi; April 7, 2005.

Kuhl CK, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 1999;211:101-110.

Morris E. Breast MRI for cancer screening in high-risk patients. Applied Radiology Supplement. May 2005; 4-9.

Partridge S, et al. MRI measurements of breast tumor volume predict response to neoadjuvant chemotherapy and recurrence-free survival. AJR. 2005;184:1774-1781.

Warner E, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical Breast examination. JAMA. 2004;292:1317-1325.

Webliography
American Cancer Society. Detailed Guide: Breast cancer, what is breast cancer? Sept 18, 2009. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_breast_cancer_5.asp. Accessed March 10, 2009.

American College of Radiology. ACR guidelines for the practice of magnetic resonance imaging (MRI) of the breast. 2008. Available at: http://www.acr.org/s_acr/bin.asp?TrackID=&SID=1&DID=17775&CID=549&VID=2&DOC=File.PDF. Accessed March 10, 2009.

BlueCross BlueShield of Tennessee. BlueCross BlueShield of Tennessee medical policy manual - magnetic resonance imaging of the breast. Oct 26, 2006. Available at: http://www.bcbst.com/MPManual/Magnetic_Resonance_Imaging_MRI_of_the_Breast.htm. Accessed March 10, 2009.

National Cancer Institute, U.S. National Institutes of Health. Calculating lifetime risk of breast cancer: questions and answers. Sept 5, 2006. Available at: http://www.cancer.gov/cancertopics/factsheet/estimating-breast-cancer-risk. Accessed March 10, 2009.

National Cancer Institute, U.S. National Institutes of Health. Surveillance, Epidemiology and End Results. Estimated new cancer cases and deaths for 2006. Available at: http://seer.cancer.gov/csr/1975_2003/results_single/sect_01_table.01.pdf. Accessed March 10, 2009.