MRI is the short for magnetic resonance imaging, in this technology with the use of magnetic and radio waves, a comprehensive & detailed cross-sectional images are produced of the inside of the body. As there is no use of x-rays, there is no exposure to radiation. In breast cancer, MRI is a very vital test and can come in useful in screening of high risk women, these are women who due to genetic reasons (gene mutation – BRCA1 or BRCA2) or family lifestyle are predisposed to cancer. Then this scan is also useful as an imaging test like mammogram or ultrasound can suspect but MRI gives a better diagnostic result. Also post treatment an MRI of the breast can be used to assess the recurrence of the cancer.
It is not like am imaging X-ray which uses radiation to produce images on film as it creates these images on the film with magnetic and radio waves and gives a 3 dimensional picture of the breast tissue. In an MRI the doctor may want the patient to undergo a kidney function test because a dye is injected in the body for this test. This dye which is injected for breast MRI may harm the kidneys of the body. This dye is a contrast solution and binds itself to the abnormal cancerous cells, due to which cancerous breast tissue is much more visible in the image on the film. They are visible as white patches on a dark background, thud being quite distinctive and clear for the radiologist. The radiologist thus is able pinpoint tissue suspected of cancer growth and may advise further conclusive tests.
In this test as it works with magnetic field, the patient would be asked by the radiologist to remove any metal bearings and also ask if there and metal chip inside the body. During this test the patient is made to lie down on a padded platform with breasts exposed which are placed in round openings on the platform. Breast coil surround each opening – these coils work with the MRI machine to create images. This platform is slid into the MRI dome/tube and the patient is supposed to lie still for the entire length of the procedure which roughly being 30 to 45 minutes. The patient can of course not feel any magnetic or radio waves but she can hear a thumping sound of the machine.
This is a specialized test and quite important in diagnosing and monitoring of the disease, as such it is imperative that the test is undertaken at a specialized facility equipped with necessary equipments. The facility should have specific MRI equipments exclusively meant for breast MRI. Also the facility should have provision for MRI guided breast biopsy. This is owing to the fact that if an abnormal cancerous suspect growth is seen in the MRI than an immediate guided biopsy can be done for immediate removal and examination of the affected tissue. Alternatively the patient may to un-necessarily undergo MRi again at another facility offering biopsy.
Breast MRI is not a favourite as a routine screening measure for a breast cancer in women. It is primarily aimed at women falling in high risk category. In is certainly considered more effective than other imaging test but it has a drawback that certain cancers which can be picked up by a mammogram imaging are not reflected in MRI imaging. Thus predominantly a MRI breast test is done in a combination with mammogram, ultrasound or other imaging tests.
This test is ideally suited for women who due to gene mutations like BRCA1 or BRCA2 fall into high risk category for breast cancer. A 13% of risk is attributed to any female for developing cancer at a given point of time. Higher than (about 20%) that categorizes a woman into high risk segment. It is suggested that such women should have a periodical breast MRI and a mammogram test in combination.
The guidelines dictate that the following characteristics define a high risk individual:
A breast MRI is useful in detecting or diagnosis of a lump/dense tissue/ mass which is not visible in ultrasound or mammography images.
A mammogram is sometimes not able to differentiate dense tissue and normal tissue. Young women who have dense breast tissue if on evaluation have a lesion or similar growth should have breast MRi done for better imaging visibility.
Breast MRI can be done in individuals with lymph nodes with cancerous growth. A MRI can help pin point the primary site of tumor growth and provide with other treatment option than only mastectomy.
A breast MRI is useful in cancer which is invasive and multi-centric with signs of growth in other areas than simply breast. For eg ILC o invasive lobular cancer has a invasive temperament and spread to surrounding and other tissues.
MRI of the breast can be done to eliminate suspected cancerous growth in other breast if one is detected to have tumor growth.
Breast MRI is useful in women with silicone implants. Silicone implants leak gel like substance in the chest wall tissue and this can easily be made out in the MRI images.
For monitoring purposes, breast MRI can be done to assess any change or growth in the breast tissue suggesting a recurrence.
Also metastatic breast cancer can easily be detected and evaluated with MRI of other parts of the body like brain, bones, spinal cord and such.
Imaging tests like MRI highlight “unidentified bright objects” also referred to as UBOs in the imaging results. Only a detailed further evaluation – clinical (chemistry), pathological (biopsy), and radiographic studies in combination can give a definite diagnosis of the type, stage and extent of cancer.