ACR PRACTICE PARAMETER FOR THE PERFORMANCE OF CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGING (MRI) OF THE BREAST

PREAMBLE

INTRODUCTION

II.

INDICATIONS AND CONTRAINDICATIONS

III.

QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL

IV.

SPECIFICATIONS OF THE EXAMINATION

IV.

SPECIFICATIONS OF THE EXAMINATION

Patient Selection and Preparation

IV.

SPECIFICATIONS OF THE EXAMINATION

Facility Requirements

DOCUMENTATION

VI.

EQUIPMENT SPECIFICATIONS

VII.

SAFETY GUIDELINES

VIII.

QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

ACKNOWLEDGEMENTS

REFERENCES

1. Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 307(13):1394-404, 2012 Apr 04.
2. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 351(5):427-37, 2004 Jul 29.
3. Kuhl C, Weigel S, Schrading S, Arand B, Bieling H, König R, Tombach B, Leutner C, Rieber-Brambs A, Nordhoff D, Heindel W, Reiser M, Schild HH. Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol. 2010 Mar 20;28(9):1450-7.
4. Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 2005;23(33):8469-8476.
5. Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365(9473):1769-1778.
6. Lehman CD, Blume JD, Weatherall P, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005 May 01;103(9):1898-905.
7. Lehman CD, Isaacs C, Schnall MD, et al. Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast cancer screening study. Radiology. 2007;244(2):381-388.
8. Morris EA, Liberman L, Ballon DJ, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol. 2003 Sep;181(3):619-26.
9. Raikhlin A, Curpen B, Warner E, Betel C, Wright B, Jong R. Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review. AJR. American Journal of Roentgenology. 204(4):889-97, 2015 Apr.AJR Am J Roentgenol. 204(4):889-97, 2015 Apr.
10. Sardanelli F, Podo F, Santoro F, et al. Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol. 46(2):94-105, 2011 Feb.
11. Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75-89.
12. Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004;292(11):1317-1325.
13. Weinstein SP, Localio AR, Conant EF, Rosen M, Thomas KM, Schnall MD. Multimodality screening of high-risk women: a prospective cohort study. J Clin Oncol. 2009 Dec 20;27(36):6124-8.
14. Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019 May;69(3):184-210.
15. Cho N, Han W, Han BK, et al. Breast Cancer Screening With Mammography Plus Ultrasonography or Magnetic Resonance Imaging in Women 50 Years or Younger at Diagnosis and Treated With Breast Conservation Therapy. JAMA Oncology. 3(11):1495-1502, 2017 Nov 01.JAMA Oncol. 3(11):1495-1502, 2017 Nov 01.
16. Gweon HM, Cho N, Han W, et al. Breast MR imaging screening in women with a history of breast conservation therapy. Radiology. 272(2):366-73, 2014 Aug.
17. Lehman CD, Lee JM, DeMartini WB, et al. Screening MRI in Women With a Personal History of Breast Cancer. Journal of the National Cancer Institute. 108(3), 2016 Mar.
18. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019 Nov 28;381(22):2091-2102.
19. Veenhuizen SGA, de Lange SV, Bakker MF, et al. Supplemental Breast MRI for Women with Extremely Dense Breasts: Results of the Second Screening Round of the DENSE Trial. Radiology. 299(2):278-286, 2021 05.
20. Monticciolo DL, Malak SF, Friedewald SM, et al. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. Journal of the American College of Radiology. 18(9):1280-1288, 2021 09.
21. Barco I, Chabrera C, Garcia-Fernandez A, et al. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease. Eur J Radiol. 85(10):1786-1793, 2016 Oct.
22. Berg WA, Gutierrez L, NessAiver MS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004; 233(3):830-849.
23. Braun M, Pölcher M, Schrading S, et al. Influence of preoperative MRI on the surgical management of patients with operable breast cancer. Breast Cancer Res Treat. 2008 Sep;111(1):179-87.
24. Chudgar AV, Conant EF, Weinstein SP, et al. Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone. Clin Radiol. 72(7):573-579, 2017 Jul.
25. Debald M, Abramian A, Nemes L, et al. Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer. Breast Cancer Research & Treatment. 153(3):531-7, 2015 Oct.
26. Elmi A, Conant EF, Kozlov A, et al. Preoperative breast MR imaging in newly diagnosed breast cancer: Comparison of outcomes based on mammographic modality, breast density and breast parenchymal enhancement. Clinical Imaging. 70:18-24, 2021 Feb.
27. Kim JY, Cho N, Koo HR, et al. Unilateral breast cancer: screening of contralateral breast by using preoperative MR imaging reduces incidence of metachronous cancer. Radiology. 2013 Apr;267(1):57-66.
28. Lehman CD, Blume JD, Thickman D, et al. Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol. 2005 Oct 01;92(1):9-15; discussion 15-6.
29. Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356(13):1295-1303.
30. Liberman L, Morris EA, Kim CM, et al. MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol. 2003;180(2):333-341.
31. Chou SS, Romanoff J, Lehman CD, et al. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology. 301(1):66-77, 2021 10.
32. Kazama T, Nakamura S, Doi O, Suzuki K, Hirose M, Ito H. Prospective evaluation of pectoralis muscle invasion of breast cancer by MR imaging. Breast Cancer. 2005;12(4):312-316.
33. Morris EA, Schwartz LH, Drotman MB, et al. Evaluation of pectoralis major muscle in patients with posterior breast tumors on breast MR images: early experience. Radiology. 2000 Jan;214(1):67-72.
34. Myers KS, Stern E, Ambinder EB, Oluyemi ET. Breast cancer abutting the pectoralis major muscle on breast MRI: what are the clinical implications?. Br J Radiol. 2021 Mar 01;94(1119):20201202.
35. Marinovich ML, Houssami N, Macaskill P, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. [Review]. J Natl Cancer Inst. 105(5):321-33, 2013 Mar 06.
36. Scheel JR, Kim E, Partridge SC, et al. MRI, Clinical Examination, and Mammography for Preoperative Assessment of Residual Disease and Pathologic Complete Response After Neoadjuvant Chemotherapy for Breast Cancer: ACRIN 6657 Trial. AJR Am J Roentgenol. 210(6):1376-1385, 2018 Jun.
37. Buchanan CL, Morris EA, Dorn PL, Borgen PI, Van Zee KJ. Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol 2005;12:1045-53.
38. Obdeijn IM, Brouwers-Kuyper EM, Tilanus-Linthorst MM, Wiggers T, Oudkerk M. MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast. AJR Am J Roentgenol. 2000 Apr;174(4):1079-84.
39. Olson JA, Jr., Morris EA, Van Zee KJ, Linehan DC, Borgen PI. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol 2000;7:411-5.
40. Orel SG, Weinstein SP, Schnall MD, et al. Breast MR imaging in patients with axillary node metastases and unknown primary malignancy. Radiology. 1999 Aug;212(2):543-9.
41. Berger N, Luparia A, Di Leo G, et al. Diagnostic Performance of MRI Versus Galactography in Women With Pathologic Nipple Discharge: A Systematic Review and Meta-Analysis. [Review]. AJR Am J Roentgenol. 209(2):465-471, 2017 Aug.
42. Boisserie-Lacroix M, Doutriaux-Dumoulin I, Chopier J, et al. Diagnostic accuracy of breast MRI for patients with suspicious nipple discharge and negative mammography and ultrasound: a prospective study. Eur Radiol. 2021 Oct;31(10):7783-7791.
43. Amitai Y, Scaranelo A, Menes TS, et al. Can breast MRI accurately exclude malignancy in mammographic architectural distortion?. Eur Radiol. 2020 May;30(5):2751-2760.
44. Giess CS, Chikarmane SA, Sippo DA, Birdwell RL. Clinical Utility of Breast MRI in the Diagnosis of Malignancy After Inconclusive or Equivocal Mammographic Diagnostic Evaluation. AJR Am J Roentgenol. 2017 Jun;208(6):1378-1385.
45. Lee CH, Smith RC, Levine JA, Troiano RN, Tocino I. Clinical usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. AJR. 1999; 173(5):1323-1329.
46. Moy L, Elias K, Patel V, et al. Is breast MRI helpful in the evaluation of inconclusive mammographic findings? AJR. 2009; 193(4):986-993.
47. Oztekin PS, Kosar PN. Magnetic resonance imaging of the breast as a problem-solving method: to be or not to be?. Breast J. 2014;20(6):622-31.
48. Sardanelli F, Melani E, Ottonello C, et al. Magnetic resonance imaging of the breast in characterizing positive or uncertain mammographic findings. Cancer Detect Prev. 1998;22(1):39-42.
49. Spick C, Szolar DH, Preidler KW, Tillich M, Reittner P, Baltzer PA. Breast MRI used as a problem-solving tool reliably excludes malignancy. Eur J Radiol. 2015;84(1):61-64.
50. Yau EJ, Gutierrez RL, DeMartini WB, Eby PR, Peacock S, Lehman CD. The utility of breast MRI as a problem-solving tool. Breast J. 17(3):273-80, 2011 May-Jun.
51. Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA. 323(8):746-756, 2020 02 25.
52. D'Orsi CJ, Sickles EA, Mendelson EB, et al. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013.
53. Grimm LJ, Soo MS, Yoon S, Kim C, Ghate SV, Johnson KS. Abbreviated screening protocol for breast MRI: a feasibility study. Academic Radiology. 22(9):1157-62, 2015 Sep.
54. Harvey SC, Di Carlo PA, Lee B, Obadina E, Sippo D, Mullen L. An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources. Journal of the American College of Radiology. 13(4):374-80, 2016 Apr.
55. Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014 Aug 01;32(22):2304-10.
56. Kwon MR, Choi JS, Won H, et al. Breast Cancer Screening with Abbreviated Breast MRI: 3-year Outcome Analysis. Radiology. 299(1):73-83, 2021 04.
57. Shellock FG, Spinazzi A. MRI safety update 2008: part 2, screening patients for MRI. AJR Am J Roentgenol. 2008 Oct;191(4):1140-9.
58. Partridge SC, Nissan N, Rahbar H, Kitsch AE, Sigmund EE. Diffusion-weighted breast MRI: Clinical applications and emerging techniques. J Magn Reson Imaging. 2017 Feb;45(2):337-355.
59. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media. Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual.
60. Kanal E, Shellock FG. Aneurysm clips: effects of long-term and multiple exposures to a 1.5-T MR system. Radiology. 1999 Feb;210(2):563-5.
61. Kanal E, Shellock FG, Lewin JS. Aneurysm clip testing for ferromagnetic properties: clip variability issues. Radiology. 1996 Aug;200(2):576-8.
62. Shellock FG. Magnetic Resonance Procedures: Health Effects and Safety. Boca Raton, Fla.: CRC Press; 2001.
63. Bussmann S, Luechinger R, Froehlich JM, et al. Safety of intrauterine devices in MRI. PLoS One. 2018;13(10):e0204220.
64. Elster AD, Link KM, Carr JJ. Patient screening prior to MR imaging: a practical approach synthesized from protocols at 15 U. S. medical centers. AJR Am J Roentgenol. 1994 Jan;162(1):195-9.
65. Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices. Playa Del Rey, CA Biomedical Research Publishing Group; 2013.
66. American College of Radiology. ACR Committee on MR Safety. 2024 ACR Manual on MR Safety. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Radiology-Safety/Manual-on-MR-Safety.pdf.
67. American College of Radiology. ACR Practice Parameter for Performing and Interpreting Magnetic Resonance Imaging (MRI). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=146+&releaseId=2
68. American College of Radiology. ACR Practice Parameter for the Performance of Magnetic Resonance Imaging-Guided Breast Interventional Procedures. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=123+&releaseId=2
69. American College of Radiology. ACR–SIR Practice Parameter For Minimal and/or Moderate Sedation/Analgesia. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=95+&releaseId=2
70. Dontchos BN, Rahbar H, Partridge SC, Lehman CD, DeMartini WB. Influence of Menstrual Cycle Timing on Screening Breast MRI Background Parenchymal Enhancement and Diagnostic Performance in Premenopausal Women. J Breast Imaging. 2019 Sep;1(3):205-211.
71. Lee CH, Bryce Y, Zheng J, et al. Outcome of Screening MRI in Premenopausal Women as a Function of the Week of the Menstrual Cycle. AJR. American Journal of Roentgenology. 214(5):1175-1181, 2020 05.
72. Espinosa LA, Daniel BL, Vidarsson L, Zakhour M, Ikeda DM, Herfkens RJ. The lactating breast: contrast-enhanced MR imaging of normal tissue and cancer. Radiology. 2005;237(2):429-436.
73. Nissan N, Allweis T, Menes T, et al. Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps. European Radiology. 30(2):767-777, 2020 Feb.Eur Radiol. 30(2):767-777, 2020 Feb.
74. Taron J, Fleischer S, Preibsch H, Nikolaou K, Gruber I, Bahrs S. Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis?. Eur Radiol. 2019 Mar;29(3):1187-1193.
75. American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=74+&releaseId=2
76. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Magnetic Resonance (MR) Imaging Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=57+&releaseId=2
77. Hendrick RE. Breast MRI: fundamentals and technical aspects. New York, NY: Springer; 2008.
78. American College of Radiology. ACR breast MRI accreditation program requirements. Available at: https://accreditationsupport.acr.org/support/solutions/articles/11000063266-complete-accreditation-information-breast-mri.American College of Radiology. .
79. Mann RM, Cho N, Moy L. Breast MRI: State of the Art. Radiology 2019;292:520-36.
80. Seiler SJ, Sharma PB, Hayes JC, et al. Multimodality Imaging-based Evaluation of Single-Lumen Silicone Breast Implants for Rupture. [Review]. Radiographics. 37(2):366-382, 2017 Mar-Apr.
81. Morris EA, Comstock CE, Lee CH, et al. ACR BI-RADS® Magnetic Resonance Imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013.
82. ShellockFrank GFGInstitute for Magnetic Resonance Safety, Education, and Research, Los Angeles, California, USA. frank.shellock@gte.net. Magnetic resonance safety update 2002: implants and devices. J Magn Reson Imaging 16:485-96, .
83. Shellock FG, Crues JV. MR procedures: biologic effects, safety, and patient care. Radiology. 2004 Sep;232(3):635-52.