Abbreviated Breast MRI Effective for High-Risk Screening without Compromising Diagnostic Accuracy

Two recent studies have revealed the effectiveness and utility of abbreviated breast MRI, not only for screening high-risk women but also in assessing "pure" ductal carcinoma in situ (DCIS). Abbreviated breast MRI emerges as a cost-effective solution, maintaining diagnostic precision while offering a shorter and safer alternative to traditional, lengthier breast MRI screenings, also facilitating smoother operations in radiology departments.

In the first study, researchers at St. Bartholomew's Hospital (London, UK) examined the performance of abbreviated breast MRI in a high-risk group for breast cancer. This study, incorporating 236 abbreviated MRI exams from 2018 to 2021, featured a six-sequence exam protocol - including precontrast T1W, T2W axial, two dynamic postcontrast, subtracted axial sequences, and MIP reconstruction - in contrast to the conventional 19-sequence approach. Four blind readers, unaware of patients’ previous imaging, history, and outcomes, analyzed the scans. The abbreviated exams identified four invasive cancers and one BI-RADS 3 lesion.

Key findings indicated that the abbreviated MRI protocol was effective in terms of negative predictive value and sensitivity. Furthermore, the average reading time for these exams was approximately 69 seconds. Agreement between the abbreviated and full protocols was high at 91.5%, although the shorter protocol had a slightly increased recall rate (9.5%) compared to the full protocol (6.1%). The study concluded that while abbreviated breast MRI showed lower positive predictive value and sensitivity compared to the full protocol, it remained a viable option for screening women at high risk of breast cancer.

In the second study, researchers at Istanbul University (Istanbul, Turkey) focused on the detection of pure DCIS using a shortened MRI protocol. Involving 25 pure DCIS cases diagnosed via biopsy and identified on breast MRI between May 2021 and October 2023, the abbreviated protocol comprised T1-weighted imaging without contrast, T1WI with first-minute contrast, and a one-minute subtraction image, reviewed by two radiologists. This approach demonstrated 80% specificity in identifying pure DCIS, confirming that such lesions can be detected effectively with an abbreviated MRI protocol.

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St. Bartholomew's Hospital
Istanbul University