Routine Breast MRI

Routine Magnetic Resonance Imaging of the Breast

MRI is a technique using a very strong magnet and radio waves to pick up signals from the breast tissue. We use state-of-the-art equipment including a dedicated bilateral breast surface coil. The patient lies face-down on a platform specially designed for Breast MRI. The primary way that abnormal tissue stands out on MRI is because it gets more blood flow than the remaining tissue. We can detect blood flow by taking images before and after infusion of an intravenous substance (gadolinium) that is easily seen on MRI. Routine Breast MRI is most useful in detecting breast cancer and evaluating the integrity of implants. Routine Breast MRI is often employed in patients with a known breast cancer in whom there is a question about how extensive the disease is.


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What is the difference between Routine Breast MRI and Abbreviated Breast MRI?

Routine Breast MRI is a longer exam (approximately 25 minutes) that is typically used in certain high-risk patients, as well as in patients who have known breast cancer, and includes additional types of images which allow better characterization of certain findings.

Abbreviated Breast MRI(AB-MR) is a shorter exam (less than 10 minutes), essentially a subset of Routine Breast MRI focusing solely on the detection of cancer. Both types of exams can be used for screening women with dense breasts.

Will insurance pay for Routine Breast MRI or Abbreviated Breast MRI?

Unfortunately, most insurance companies do not pay for Breast MRI in the majority of women who need it, namely those with dense breasts. It is for this reason that Via Radiology developed its Abbreviated Breast MRI (AB-MR) program, which is an out-of-pocket expense that is a fraction of the cost of Routine Breast MRI, often lower than a patient’s deductible.

The cost of a Routine Breast MRI varies, and is subject to insurance.

How accurate is MRI at detecting breast cancer?

Breast MRI is by far the most accurate breast imaging test in use today. It is exceedingly rare for breast MRI to miss an invasive breast cancer. To put this into perspective:

  • Mammography detects 4-5 cancers per 1000 women screened.
  • Ultrasound detects an additional 2-4 cancers per 1000 women screened.
  • Breast MRI detects an additional 16-23 cancers per 1000 women screened.
If MRI is so accurate, why has MRI not been used more often?

Breast MRI has been recommended for many years for screening women who are at high risk for developing breast cancer. The reason it has been limited to these women is primarily because of its high cost. However, there is a new low cost breast MRI exam that has been developed specifically for screening women with dense breasts, called Abbreviated Breast MRI (AB-MR). AB-MR does not have radiation, does not require breast compression and has the same accuracy as the standard exam.

Who reads the Breast MRI exams?

Via radiologists, specifically trained in MRI of breast related diseases, perform and interpret the study. We utilize a special computer-assisted detection (CAD) program designed for the processing and interpretation of Breast MR Images. Because we are Breast Imaging specialists, we can achieve maximal integration of breast imaging studies so that the patient achieves the best possible care.

If I get a Breast MRI do I also need to have mammograms?

Based on current scientific information, it is recommended that you continue with mammograms every year starting at age 40 in addition to any other screening that you may undergo.

How often should I get Breast MRI screening?

Official guidelines for breast MRI screening in women of average to intermediate risk have not been established. However, based on currently available data from the medical literature along with American Cancer Society and American College of Radiology guidelines, we recommend the following breast MRI screening intervals (in addition to yearly mammograms):

1. Average risk and dense breasts, less than age 55: Breast MRI every 2 years
2. Average risk and dense breasts, 55 and older: Breast MRI every 3 years
3. Intermediate risk and dense breasts, less than 55: Breast MRI every year
4. Intermediate risk and dense breasts, 55 and older: Breast MRI every 2 years
5. High risk, any breast density, any age: Breast MRI every year
6. Personal history of breast cancer and dense breasts, any age: Breast MRI every year
7. Personal history of breast cancer diagnosed before age 50, any breast density: Breast MRI every year

Note: Abbreviated breast MRI (AB-MR) is offered as a lower cost, out-of-pocket alternative when standard breast MRI is not covered by the patient’s insurance.

What should I do if I have dense breasts?

If you have dense breasts, please talk to your doctor. Together, you can decide if additional screening is right for you and, depending on your risk, how often you should get it. We highly recommend AB-MR as the best screening option. AB-MR exams are read by our expert breast imaging radiologists at Seattle Breast Center.

What about false positive test results?

No breast cancer screening test is perfect. There will be times when something is found that requires further testing, including possibly a needle biopsy, to determine if there is truly a cancer present. If it turns out that no cancer is present, it’s called a false positive. Ultrasound has the highest false positive rate. Fortunately, when read by expert breast imaging radiologists, the false-positive rate for AB-MR is relatively low and similar to mammograms.

Will my menstrual cycle have an effect on image quality?
For premenopausal women, the hormonal changes that occur during your menstrual cycle can have a major effect on the accuracy of breast MRI (it can result in more false positives and potentially make it more difficult to detect a cancer). Assuming a normal 28 day cycle with day 1 being the first day of your menstrual period, the best time to have a breast MRI is between day 5 and 15, although ideally between day 7 and 10.  In other words, week 2 is the best time. The worst time is during the last week of your cycle. If you have irregular cycles or you are less than age 55 and have had a hysterectomy but still have your ovaries, the radiologist will do his best to accurately interpret your examination without the benefit of ideal timing of the exam
Can I eat and drink before my Breast MRI exam?

Yes, you may eat and drink before this exam.

What if I am pregnant or nursing?

We do not perform routine breast MRI for women who are pregnant or are breast feeding.

What if I am claustrophobic and fearful of small spaces?

Some patients become fearful or agitated in small, enclosed areas (claustrophobic) or experience discomfort when lying on their chest for 10-20 minutes. If you dislike small spaces or have difficulty lying down on your stomach, please ask your referring health care provider to prescribe a relaxant or pain medication to help you through the exam.

I plan to take pain medication. Do I need a driver?

Yes, you do. If you plan to take relaxation or pain medication before your exam, it is our policy that you come with someone who can drive you home.

What if I have had a mammogram at a different facility within the last two years?

If you have had a mammogram at a facility other than the Seattle Breast Center within the past two years, it is helpful to your evaluation to bring it with you at the time of your exam. You should be able to get a copy of your images by contacting the facility.

When should I arrive?

When you schedule your exam, you will be given an arrival time of 30 minutes before your actual scan time.

What should I wear?

Do not wear anything metallic during the MRI exam. You will be asked to change into a gown in our changing area, where you can lock your valuables and/or any metallic objects in a locker.

What if I have additional questions prior to the exam?

You will fill out a questionnaire during an interview process with one of the female MRI technologists. She will be able to answer any additional questions or concerns you may have.

Will I need to anticipate in any injections?

A small amount of dye (contrast agent) is injected during the exam to enhance visualization of a possible cancer. The technologist will place a small intravenous (IV) catheter in your arm for the injection.

What can I expect during the procedure?

After being escorted to the MRI room, you will be asked to lie face down with your breasts placed in a hollow depression in the scanning table, which contains coils that detect radiofrequency signals from the MRI machine. Your arms will be at your side or above your head. For comfort and optimal imaging, the coils we use can be customized for each breast. A premium headrest also enhances your comfort and warm blankets are available.

The scanning table will slide your entire body into the large, central opening of the MRI machine. The MRI machine creates a magnetic field around you, and radio waves are directed at your body. You won’t feel the magnetic field or radio waves, but you may hear loud tapping, thumping and other sounds coming from inside the machine. Headphones are provided with music, which help dampen the noise and allow the technologist to communicate with you during the exam.

Do I need to lie still throughout the entire MRI exam?

Yes. Breast MRI is very sensitive to motion, which may not only cause inaccurate test results, but require that the exam be repeated on another day. You will be instructed to breathe normally but to lie as still as possible until the exam is completed. Therefore, it is important that you are in a comfortable position before the scanning starts.

How long does the exam take?

Sets of images, called pulse sequences, will be obtained for 1-4 minutes at a time with breaks in between. During the breaks it is important that you remain still. Abbreviated Breast MRI generally takes less than 10 minutes, whereas Routine Breast MRI generally takes approximately 25 minutes.

Will a technologist be nearby?

The technologist is always able to see and hear you during the exam, but we attempt to keep talking to a minimum to reduce the chance of movement, which can blur the images.

What can I expect after the exam?

The IV will be removed from your arm and you may go to the changing area to prepare to leave.

Can I drive myself home?

Unless you took relaxation medication, there are no restrictions placed upon you. You may eat and drive. If you took relaxation medication, you will need someone to drive you home.

When can I expect to receive results?

Your breast MRI exam will be interpreted by one of our radiologists specializing in breast imaging. A report will usually be available within one business day of your exam.


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