MAGNETIC RESONANCE IMAGING OF THE BREAST: A PROBLEM SOLVING TOOL

Approximately one in every nine Pakistani women is likely to suffer from breast cancer. This is one of the highest incidence rates in Asia. Mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. Breast magnetic resonance imaging (MRI) has become increasingly important in the detection and delineation of breast cancer in daily practice. The utility of diagnostic value of MRI is mainly on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional imaging, assessing for the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer. The standard breast MRI protocol includes T2 sequences (anatomy and signal analysis), T1 gradient-echo sequences which can detect markers placed after biopsy, and injected dynamic 3D sequences for performing volume and multiplanar reconstructions, which are particularly useful for locating lesions. Good patient positioning is essential. These aspects limit movement artefacts which alter subtraction sequences; it must be compared with the native sequences. New functional imaging sequences are now appearing in an attempt to increase the specificity of MRI, which is one of its main limitations. Of these, magnetic resonance spectroscopy appears to be the most promising.