Why Are Breast MRIs Performed?
Breast MRI is generally a supplemental exam that provides additional information after another imaging test, such as a mammogram or breast ultrasound. We use breast MRI to:
- Screen for breast cancer in high-risk patients
- Evaluate symptoms
- Determine the extent of breast cancer
Breast MRIs provide a more detailed look at the breasts for preventive or diagnostic purposes. Sometimes a breast MRI is performed as a preventative imaging scan in high-risk women with a strong family history of breast cancer. These women may undergo regular MRI screening to look for subtle differences that may represent cancer. A Preventative Breast MRI (Breast MRI Screening) because of family history or genetic risk factors usually requires authorization from your insurance company. MRI for immediate treatment care in women with a new cancer diagnosis may not require insurance authorization.
Breast MRI is also used as a diagnostic imaging radiology exam. It can evaluate the extent of disease in patients with a recent breast cancer diagnosis. Contrast MRI imaging looks for additional breast cancers within either breast. This examination can be invaluable for surgeons as it provides a detailed map before surgery.
It's important to know that mammograms should be the first approach to breast imaging, and the MRI is a supplemental imaging scan.
How a Breast MRI Is Performed
We will ask for a complete history of any medical conditions and any surgeries you have had in the past. Please tell the scheduler and technologist if you have any metal in your body, such as metal fragments from trauma or surgery, that could affect the “magnetic pull” of the MRI. Before scheduling, let the technologist know if you have any planted devices, as MRI may not be possible with some. These include:
- Aneurysm clips
- Auditory hearing implants
- Internal wires or electrodes
- Implanted pumps or ports
- Surgical mesh
- Any coils, stents, or filters
Some of the newer pacemakers and defibrillators are compatible with MRI, while older devices are not, so it is important to know from your surgeon and the manufacturer what kind you have. Some external body modifications, such as body or face/makeup tattooing or permanent piercings, may limit you from having an MRI. Current or prior metal workers may have small fragments in their eyes as an occupational hazard.; therefore, we may request an X-ray before performing the MRI. Due to the magnets, you must remove any jewelry and piercings for your safety. Please see our MRI Safety Form for more information.
We may inject a contrast dye called gadolinium into your arm vein, which helps us get more detailed images of tissues. Please tell the scheduler and the MRI technologist if you have ever had an allergic reaction to a contrast agent. The dye used in MRI is different from that used in a CT exam. For most people, this is not an issue.
You will lie on your back on a comfortable table that moves in and out of the MRI machine. Because the magnets make a loud, clunky sound, the technologists will fit you with comfortable headphones through which you may choose to listen to music. Many patients find the exam soothing because of the music and may fall asleep. Do not move quickly or jerk during the exam because this may cause irregularities in the images.
Your breast MRI will produce hundreds of images in various sequences. Therefore, your results will not be immediately available. An MRI specialist or the patient navigator will call you regarding your results once the interpretation is complete. If you have had any prior examinations elsewhere, please let us know the location so we can obtain these for faster comparison. You might have to sign a release form so that we may request this transfer. We will also send a copy of your report to your ordering clinician, and they will discuss any further action recommended based on your imaging results. Preventative MRI (screening MRI) because of family history or genetic risk factors usually requires authorization from your insurance company. MRI for immediate treatment care in women with a new cancer diagnosis may not require insurance authorization.
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Frequently Asked Questions About Breast MRIs
One breast imaging examination is not better than the other. There are different types of imaging examinations performed for different indications. Mammograms are still considered the first line in breast imaging, and the MRI is a supplemental imaging scan for “high-risk imaging” or to evaluate the “extent of disease" after an abnormal breast biopsy.
Some women with a strong family history of breast cancer or other personal risk factors may be recommended to perform breast MRI on a regular basis to look for subtle vascular differences in the breast tissue that may represent early cancer.
Mammography can still detect some types of breast cancer that MRI can not detect so some women may need both. The American College of Radiology does not recommend MRI of the breast for women of average or low risk because of the chance of false alarms.
A Breast MRI is commonly performed to distinguish normal versus pathological tissues. In an asymptotic woman with a strong family history of breast cancer, a surveillance MRI may show subtle vascular changes in adjacent tissues that allows early cancer to stand out. In women with a recent abnormal breast biopsy for a precancerous or cancerous condition, MRI helps to eliminate other areas of concern or provide a map for the breast surgeon preoperatively. MRI of the breast can also be used as a diagnostic scan to find the reason for a persistent complaint as bloody nipple discharge that cannot be detected on diagnostic mammogram or ultrasound imaging.
The Women's Imaging Center Radiologist or your referring clinician will determine if this exam is the best one for you. Most MRIs require insurance authorization which we will obtain from your carrier. This process can take up to 72 working hours, but some insurance plans may take longer than others to approve the examination.
Breast MRIs require intravenous contrast to show subtle differences in tissue types so an IV will be inserted in the arm or hand. If you have never had an IV placed, it's a very tiny flexible catheter through which we inject the contrast agent (called Gadolinium). You lay comfortably on your abdomen and the padded breast coils are fitted around the breasts, and your MRI technologist checks your position and preliminary imaging before the administration of contrast. Both breasts are scanned at the same time.
The technologist then injects the contrast dye which is taken up differently in different types of tissues to different degrees. The coils are used to pick up the MRI signals. The signals are converted to images for the radiologists to interpret. There are often more than 1,000 images to review so the examination results are not immediately available.
The amount of time that an MRI takes depends on whether contrast dye needs to be administered or whether special imaging sequences are needed. Almost all breast MRI requires the use of intravenous contrast. However, if the MRI examination is ordered to evaluate breast implants alone (not the breast tissue), then contrast is not required. The usual time for MRI of the breasts for either indication takes approximately 35 minutes.
For preventative or screening MRI examinations, you will be notified by mail regarding your results with instructions of whether any follow up is indicated. We will coordinate that follow up through our office. Your referring clinician will also receive a copy of that report.
However, if the exam is performed for a diagnostic reason such as after an abnormal breast biopsy, your ordering clinician or surgeon receives that report. The clinician who will act on those results will discuss those results at your consultation.