RadteraBreast MRI - Extent of Disease / Staging
MR+ ContrastBreast
Indications
- Newly diagnosed breast cancer: assess local extent, multifocal/multicentric and contralateral disease
- Evaluation of invasive lobular carcinoma (often mammographically occult/underestimated)
- Assessing response to neoadjuvant chemotherapy (pre/mid/post-treatment)
- Occult primary with axillary nodal metastasis; problem-solving when other imaging is equivocal
- Evaluating chest wall/pectoralis involvement and nipple-areolar complex
Patient prep
- Same gadolinium/renal and safety screening as screening MRI
- Cycle timing less critical than for screening but still preferred days 7-14 in premenopausal patients when feasible
- Coordinate timing relative to recent biopsy (post-biopsy change can confound); prone, dedicated breast coil
Contrast
AgentGadolinium-based contrast agent (macrocyclic preferred)
RouteIV
Dose0.1 mmol/kg
TimingDynamic 1 pre + multiple post-contrast phases; early peak ~90 s-2 min plus delayed
Technique
- Same DCE protocol as high-risk screening, with attention to whole-breast and chest-wall coverage
- Measure index lesion(s) and document distance to nipple, skin, and chest wall; map additional sites
- Assess contralateral breast and axillary/internal mammary nodes
- For neoadjuvant response: compare tumor size/enhancement and kinetics across time points
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | T2-weighted (fat-suppressed) | Axial | Edema, nodal/skin involvement |
| 2 | Dynamic T1 FS 3D GRE pre + post | Axial | Index lesion size, satellites, NME extent; subtraction/MIP |
| 3 | Delayed post-contrast | Axial/sagittal reformats | Washout assessment; chest-wall and NAC evaluation |
| 4 | DWI (optional) | Axial | Treatment-response adjunct |
Key points
- Most sensitive for additional ipsilateral and contralateral foci that alter surgical planning
- Confirm MRI-detected additional lesions histologically (targeted US +/- biopsy or MRI-guided biopsy) before changing management
- Particularly valuable for invasive lobular carcinoma extent
- Report with MRI BI-RADS and clear lesion mapping for the surgeon
References
• ACR Practice Parameter for the Performance of Contrast-Enhanced MRI of the Breast
• ACR Appropriateness Criteria (staging / extent of disease)
• ACR BI-RADS Atlas, 5th ed. (MRI)
• Radiopaedia: Breast MRI ( link
• ACR Appropriateness Criteria (staging / extent of disease)
• ACR BI-RADS Atlas, 5th ed. (MRI)
• Radiopaedia: Breast MRI ( link
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.