Implementation of abbreviated breast MRI in diagnostic and screening settings

Abstract

Background

Abbreviated magnetic resonance imaging (MRI) includes fewer sequences than standard MRI, which could be utilized for breast cancer detection.

Purpose

To evaluate the diagnostic accuracy of abbreviated MRI protocol in screening and diagnostic settings.

Material and Methods

All women with screening and diagnostic (problem-solving and preoperative staging) MRI examination were recruited from 2017 to 2020. Two expert radiologists assessed designed abbreviated protocol (fat-saturated T1-weighted [T1W] pre-contrast and two first fat-saturated T1W post-contrast series with reconstruction of their subtraction) including maximum intensity projection (MIP) and then evaluated standard protocol of breast MRI. Associated findings, including axillary lymphadenopathy and invasion to nipple, skin, or pectoralis muscle were also evaluated. The concordance rate of abbreviated with standard protocol in screening and diagnostic settings were also compared, based on BI-RADS classification. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value were calculated.

Results

A total of 108 (26.5%) of 408 patients (mean age = 43 ± 9 years) were classified as BI-RADS 4–5 and considered positive findings based on suspicious enhancement (mass or non-mass enhancement). Compared to standard protocol, abbreviated protocol revealed >98% accuracy in the diagnostic setting as well as 100% accuracy in the screening setting. Concordance rates in screening and diagnostic settings were 99.6% and 98.1%, respectively. There was no discordance between abbreviated and standard protocol in the evaluation of associated findings.

Conclusion

Abbreviated MRI protocol possesses substantial diagnostic accuracy in both screening and diagnostic settings. Additional information provided by standard protocol might not require for cancer detection.