RadteraMRI Breast With and Without Contrast (Bilateral)
MR+ ContrastBreast
Indications
- High-risk screening (e.g., BRCA, >20% lifetime risk)
- Extent of disease / staging of known cancer
- Problem solving / occult primary
- Neoadjuvant chemotherapy response
- Implant integrity (silent rupture)
- Suspected recurrence
Patient prep
- Schedule day 7-14 of menstrual cycle (premenopausal) to reduce background enhancement
- MRI safety screening; IV access for contrast
- Prone in dedicated bilateral breast coil, arms positioned to reduce wrap
- For implant evaluation, may be non-contrast with silicone-specific sequences
Contrast
Agentgadolinium-based
RouteIV
Dose0.1 mmol/kg power-injected with saline flush
TimingDynamic: pre-contrast then multiphase post-contrast (early ~90 s peak, plus delayed) for kinetics
Technique
- Prone bilateral dedicated breast coil; high spatial AND temporal resolution dynamic 3D T1 fat-sat
- Pre-contrast and serial post-contrast 3D fat-sat T1 for enhancement kinetics (wash-in/washout)
- Subtraction images (post minus pre) to highlight enhancement
- T2/STIR for cysts, edema, lymph nodes; DWI increasingly added; silicone-selective for implants
Series / Sequences
| # | Series / Sequence | Plane | Weighting / Recon | Thickness | Notes |
|---|---|---|---|---|---|
| 1 | Ax T2 / STIR | axial | T2/STIR | 3-4 mm | Cysts, edema, nodes |
| 2 | Ax DWI/ADC | axial | DWI | 4 mm | Adjunct for malignancy |
| 3 | Ax 3D T1 fat-sat pre | axial | T1 FS | 1-3 mm | Dynamic baseline |
| 4 | Ax 3D T1 fat-sat post (multiphase) | axial | T1 FS +C | 1-3 mm | Kinetics; early + delayed phases |
| 5 | Subtraction / MIP | axial | T1 +C subtraction | N/A | Enhancement display |
| 6 | Silicone-selective (implants) | axial | Silicone-specific T2 | 3-4 mm | Only for implant integrity |
Key points
- High spatial and temporal resolution dynamic imaging is essential to characterize lesions (BI-RADS morphology + kinetics).
- Time premenopausal screening to days 7-14 to minimize background parenchymal enhancement.
- Subtraction and MIP images aid detection; assess enhancement curve (persistent/plateau/washout).
- DWI improves specificity. Implant rupture uses non-contrast silicone-selective sequences (linguine sign).
- Bilateral coverage and full axilla for nodal assessment.
References
• ACR Practice Parameter for the Performance of Contrast-Enhanced MRI of the Breast
• ACR BI-RADS Atlas (MRI)
• Radiopaedia: Breast MRI protocol link
• RadioGraphics: Breast MRI
• ACR BI-RADS Atlas (MRI)
• Radiopaedia: Breast MRI protocol link
• RadioGraphics: Breast MRI
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.