During the preparation of examination techniques 2 I found particularly interesting use of the technique in breast MRI in this context I found an article that I reproduce below:
"The Breast Magnetic Resonance Imaging (RMM), introduced to 'beginning of the nineties, has finally entered clinical use with well-defined indicators to complement traditional techniques for breast imaging (mammography and ultrasound). It' important to define the precise indications, however, the implementation of this method in order to maximize the 'use and exploit its undoubted potential. E' for this requirement which was recently drafted a document Consensus on Breast MRI during a recent conference held in Florence, published in the journal "News in Breast", year XIII, No. 53, February-May 2008.
breast MRI can be performed with or without the use of contrast medium (CM) paramagnetic in relation to specific clinical indications.
breast MRI without contrast is performed primarily for the study of the implants, particularly in the evaluation of its integrity and possible complications, the prosthesis is applied for cosmetic purposes, both for reconstruction after cancer operations. E 'indicates the completion of investigation by the administration of paramagnetic contrast agent during the same session of breast MRI in clinical suspicion and / or conventional imaging of concomitant parenchymal nodule.
The main indications for breast MRI with contrast are: the surveillance of women at high risk: this refers to women at high genetic-familial risk of breast cancer patients with positive genetic test for pathogenic mutations of BRCA1, BRCA2 or TP53 ( Li-Fraumeni syndrome), patients in which the same mutations were found in a first-degree relative without their own have performed genetic testing and women with significant family history of breast cancer evaluated by a geneticist, oncologist. In these patients we recommend performing a breast MRI every year, in the context of programs surveillance that also include clinical examination, mammography and ultrasound. The age of onset of such controls may be about 5-10 years before the age when cancer was diagnosed in the family. In women younger than 36 years the control can only be made with clinical examination, ultrasound and breast MRI.
local staging pre surgery: breast MRI is indicated in particular in women with multiple lesions in the same breast (multifocal or multicentric) or in the contralateral breast suspect conventional imaging or clinical examination;
evaluate the effect of chemotherapy (CT) Neoadjuvant: in patients with locally advanced breast cancer, breast MRI is the most accurate in assessing response to neoadjuvant treatment (chemotherapy before surgery) to run normally before, during and after the therapy.
the assessment of breast carcinoma treated with conservative surgery and / or radiotherapy, in particular for the differential diagnosis of local recurrence (or residual disease) and surgical scar: the implementation of breast MRI is indicated for its greater sensitivity and specificity in patients with clinical examination and / or conventional imaging suspicious, especially when the biopsy is not technically executable, is unlikely to be conclusive or inconclusive result. Moreover, this method is useful when you need to assess the extent of relapse and define the appropriate therapeutic approach;
syndrome unknown primary carcinoma: an indication for elective breast MRI the detection of biopsy diagnosis of metastatic lymph node or elsewhere likely to be breast primary tumor, with negative clinical and conventional imaging (CUP syndrome = Carcinoma of Unknown Primary) breast MRI in these cases showed high levels of sensitivity, showing the primary lesion is not visible with other methods, allowing you to proceed to appropriate treatment;
in the breast with nipple discharge: the breast MRI has shown high accuracy in detecting breast lesions in patients with suspicious or doubtful secretions (blood, blood serum ..), not identified with traditional techniques, particularly in cases galactography which is unworkable or inconclusive. There is no evidence that this has no doubt useful in characterizing conventional diagnostic imaging is feasible in situations where a levy agobioptico mammography or ultrasound guidance or not in asymptomatic women at high risk (with negative conventional imaging) "
