Click on any image below to see an enlargement of that image.

Case 1: 79 year old woman with prior mastectomy for breast cancer
Normal dense mammogram. (Difficult to evaluate)	Normal MRI.
Case 2: 63 year old woman with questionable “thickening” of the left breast
Normal left breast mammogram	MRI reveals multifocal invasive ductal carcinoma
Case 3: 69 year old woman with a normal breast exam
Screening mammogram shows a focal new density in the left breast	MRI reveals multifocal cancer in the left breast and a solitary unsuspected cancer in the right breast
Case 4: 63 year old with a recent lumpectomy for breast cancer
Mammogram shows a normal sized lymph node which has remained stable for four years	MRI demonstrates malignant enhancement of this lymph node (biopsy proven cancer)

Above images are all original MR scans performed at Parkside MR Center.

Imaging Breakthrough

With the advent of state-of-the-art dynamic MRI Mammography, the ability to diagnose minimally invasive breast cancer has been catapulted to a new level. With an inherent false negative rate better than that of film-screen mammography, and a specificity of 90-95%, clinical breast MRI is now being used more frequently as an adjunctive imaging modality to conventional mammography and ultrasound.

In addition to its more traditional applications (e.g., implant evaluation, fibrosis versus tumor recurrence), MRI now has been proved effective in:

1. morphologically differentiating between normal tissue and malignancy in the extremely dense fibrocystic breast;
2. accurately identifying and quantifying multifocal disease in suspected or pathologically-proved neoplasm;
3. characterizing nodal status.

Although not recommended as a routine screening test at this time, breast MRI, in the appropriate clinical setting, is an invaluable diagnostic tool when used together with careful physical examination of the breast, conventional mammography, and targeted ultrasound.

Lisa Laurent, M.D.
Director, Mammography
Lutheran General Hospital

Discussion

Breast MRI now provides physicians a powerful new tool in the early diagnosis of breast cancer. Although plain film mammography has been the mainstay in the detection of breast cancer, up to 15% of palpable breast cancers are not seen on mammograms. Breast MRI, by detecting the abnormal blood flow associated with cancer, can detect breast cancer before it is seen on mammograms.

Dr. Werner Kaiser of Jena, Germany, developed the techniques of breast MRI utilized at Parkside.¹ Utilizing his method of rapid scanning, researchers have found that MRI can detect 100% of breast cancers in high risk women.² Parkside MRI Center is the only facility in the Chicago area currently utilizing the methods perfected by Dr. Kaiser.

As more is learned about MR imaging for the detection and staging of breast cancer,³ indications for this study continue to expand. Breast MRI may give valuable information in the following patients:

• when a question arises on a routine mammogram
• when a lump is discovered on physical exam
• in patients with dense breasts on mammography and a family history of breast cancer
• in patients scheduled for a needle or surgical biopsy
• in patients with a history of prior breast cancer
• in patients who have had multiple prior biopsies
• in patients with breast implants

References

Clinical Comment

Over the past several months, our institution has investigated the utility and feasibility of breast magnetic resonance imaging through the Caldwell Breast Center. The initial results of this investigative approach have been quite promising. Several patients have undergone breast MRI and, because of this advanced scanning technique, multiple abnormalities have been detected which have assisted the clinical evaluation and have helped direct further clinical management decisions. This breast MRI technique has been most helpful in patients who have indeterminate mammograms. Patients with extremely dense breasts or those that have multiple areas of abnormality on a mammogram are, in my experience, the patients that most frequently may benefit from breast MRI. The MRI allows the clinician and the radiologist to select the most suspicious area for biopsy and further evaluation. This technique also allows the clinician to evaluate potential areas of in situ disease and aids in the search for multifocal or bilateral subclinical cancer. We are quite excited about our initial foray into this new modality through the Caldwell Breast Center and hope to expand our experience over the next 12-18 months.

James R. Dolan, M.D.
Director, Caldwell Breast Center
Lutheran General Hospital

To find out more about Breast Imaging and other services at Parkside MR Center, visit our web site at www.parksidemri.com or call us at (847) 696-7900.

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