Breast MRI coils and abbreviated breast MRI

Breast MRI is acquired prone, with the breasts hanging into a dedicated multi-channel radiofrequency coil that provides the signal for high-resolution imaging and, in biopsy-capable designs, open access for MRI-guided vacuum biopsy; coils are made by the scanner vendors and specialist firms and are used on 1.5 T and 3 T systems. The standard protocol takes 20 to 40 minutes: fat-suppressed T2 images, diffusion, and a dynamic series before and several times after gadolinium contrast to characterise how lesions enhance and wash out. Abbreviated MRI, proposed in 2014, keeps only the pre-contrast and first post-contrast images with a subtraction and maximum-intensity projection, taking about three minutes of scan time and a minute of reading, while detecting cancers at a rate similar to the full protocol. The ECOG-ACRIN EA1141 trial found abbreviated MRI detected more invasive cancers than tomosynthesis in women with dense breasts, and the Dutch DENSE trial showed that supplemental MRI reduced interval cancers in women with extremely dense breasts. MRI screening is already standard for BRCA carriers and other high-risk women.

The limits are gadolinium injection, false positives that generate biopsies, scanner capacity and price, contraindications from implants and claustrophobia, and the need for coil-equipped scanners and trained readers; abbreviated protocols address the time and cost but not the contrast or the false-positive rate.