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Breast MRI Guidelines

The role of magnetic resonance imaging (MRI) of the breast continues to evolve. Currently, it is dependent on your diagnosis, your physical health, and your medical and family history, among other concerns. Your physician will discuss with you whether MRI is appropriate for you based on all these factors.

While MRI has an important role in breast imaging and diagnosis, it does not replace the gold standard of mammography and, if indicated, ultrasound.

  • Experts at Loyola Breast Care support the following indications for MRI in breast imaging based on current literature. They are presented from most common usage to least common usage among patients:
  • Determine the local extent of breast cancer if you are newly diagnosed. MRI may be useful in determining the tumor size, and whether you have a single tumor or multiple sites within the same breast. Imaging also is conducted on the opposite breast to insure that you have no significant disease in that breast.
  • Determine the extent of disease that might remain following a lumpectomy (positive margins).
  • Monitor your response to neoadjuvant therapy (chemotherapy or hormone therapy to shrink the cancer prior to surgery). MRI often is used to gauge the tumor shrinkage.
  • Assess the extent of a localized recurrence of your breast cancer.
  • Identify an otherwise undetectable primary breast cancer when there is known involvement of the lymph nodes in the armpit. MRI potentially can identify the primary tumor and may prevent the need for a mastectomy.
  • Provide additional images following a non-conclusive mammogram/ultrasound (the "problem mammogram"). You may need an MRI if you have an abnormal mammogram and/or ultrasound that the radiologist or your physician treating you believes  requires additional examination (one example is a lesion seen on only one view on mammography).
  • Assess your condition if you are a “high risk" patient. You are considered high risk if you have a BRCA1 or BRCA2 gene mutation, have a previous history of breast cancer or biopsy-proven high-risk lesion (ADH, LCIS), have a history of mediastinal irradiation or have a significant family history of breast cancer.
  • Evaluate silicone implants and any potential complications or leakage.

You should be aware that additional radiological studies or biopsies may be ordered following an MRI. Limitations of MRI may result in a number of false-positive readings.

Despite these current indications used by your physician to order a breast MRI, not all MRI studies are reimbursed by third-party payors. Be sure to check with your insurance provider about your specific coverage.

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