Breast MRI — High-Risk Screening & Problem-Solving

Breast MRI

The most sensitive test for invasive breast cancer — used where that sensitivity earns its place: high-risk screening, staging and specific problem-solving.

How it works

Breast MRI is dynamic contrast-enhanced: images are taken before and repeatedly after gadolinium. Cancers tend to enhance early and wash out, and the shape/kinetics of enhancement drive interpretation, reported with the BI-RADS lexicon. It is performed prone in a dedicated breast coil.

Very high sensitivity, moderate specificity — MRI finds cancers mammography misses but also flags benign enhancement, so it is targeted rather than universal.

Main indications

High-risk screening: annual MRI (with mammography) for BRCA carriers and other high-lifetime-risk women.
Staging: extent of known cancer, multifocal/multicentric or contralateral disease in selected cases.
Occult primary: axillary nodal cancer with a normal mammogram/ultrasound.
Neoadjuvant response: monitoring tumour response to chemotherapy.
Implant integrity: a non-contrast protocol assesses silicone implant rupture.

Practical notes

Timing to the menstrual cycle (around days 7–14) reduces background enhancement in premenopausal women. MRI-detected lesions often need MRI-guided (or second-look ultrasound) biopsy. Abbreviated MRI protocols are emerging to widen access.

Reference: Mann RM et al. Breast MRI: EUSOBI recommendations for women’s information. Eur Radiol 2015;25:3669–78.

Educational summary for clinicians; screening eligibility and pathways follow local guidelines. Not medical advice.