We have provided
the answers to some of the most common and frequently asked
questions. If you need additional information, you can contact our
office at 6 Ohio Drive in Lake
Success, at 516-684-4774.
What
is Breast MRI?
Breast MRI (Magnetic Resonance
Imaging) is a highly sensitive but non-invasive imaging tool which can
be used for the detection of breast cancer. It is an adjunct to
traditional breast imaging modalities (mammography and ultrasound) and
does not replace yearly mammography screening.
Breast MRI is a cross-sectional imaging
technique which produces hundred of images of the breast. In general,
the images are taken both before and after the injection of
intravenous contrast or dye. The contrast agent, called gadolinium,
helps to highlight abnormal areas in the breast and is tolerated very
well by most patients.
Breast MRI is very sensitive to all
abnormalities in the breasts including malignant and benign processes
which have increased blood flow.
Who
should have Breast MRI?
There are several indications
for Breast MRI including:
Preoperative planning or staging of
newly diagnosed breast cancer.
Surveillance for individuals who have
an increased risk for breast cancer including those with strong
family history of breast cancer, a personal history of breast
cancer, a history of high risk lesions such as atypical ductal
hyperplasia (ADH) or lobular carcinoma in situ (LCIS), or for
those with the breast cancer gene (BRCA1, BRCA2).
Monitoring the effect of
chemotherapy.
Evaluation of equivocal findings on
mammography or ultrasound.
Evaluation of breast implants for
rupture.
What
is the Breast MRI exam like?
When you arrive at our office,
you will be asked to fill out a questionnaire focused on your medical
history related to breast disease. It is important to answer to the
best of your ability and to bring any prior mammogram, ultrasound and
MRI films.
When you are called for your exam, you
will change into a hospital gown. Personal items such as your watch,
wallet, credit cards, cell phones and any electronic devices, hearing
aids, jewelry, metal hair clips etc. will need to be removed in order
to obtain the highest quality exam. This is both to protect you, your
belongings and to obtain the highest quality exam. It is advisable to
leave valuables at home if possible.
An intravenous line will be started by a
nurse or doctor in order to administer the contrast material,
gadolinium. This contrast agent is well tolerated by almost every
patient. The actual exam time is approximately 30 minutes. During the
exam you will lie on your stomach with each breast positioned in an
indentation in the table. Ear plugs are supplied to muffle the loud
sounds made by the scanning machine. Images are taken in rapid
succession both before and after the injection of the intravenous
contrast. It is very important to stay very still in order to get the
best pictures, just like when you are taking a photograph. At the end
of the exam, the intravenous catheter is removed. You can resume
normal activities for the remainder of the day.
Once all of the images have been
generated and processed through special computer programs, one of our
specialized doctors, a board certified radiologist, will interpret the
exam in conjunction with any prior imaging studies. You will receive
the test results from your referring physician usually within a few
days.
Is
Breast MRI safe?
MRI is a safe exam for most
patients. There is no radiation. The main contraindications to having
any type of MRI include: heart pacemaker, cerebral aneurysm clip,
medication pumps, implanted nerve stimulators, cochlear implants, or
some breast tissue expanders.
People with the following medical devices
can be safely imaged: surgical clips or sutures, artificial joints,
surgical staples, most heart valve replacements, vena cava filters,
disconnected medication pumps, brain shunts for hydrocephalus.
We do not routinely perform Breast MRI on
pregnant or nursing women.
What
are the pros and cons of Breast MRI?
Breast MRI is very sensitive
for the detection of breast cancer. It can show breast cancers that
are not visible on mammogram or ultrasound, particularly in patients
with dense breasts. In addition, it is better than mammogram or
physical exam in defining the extent of disease when a diagnosis of
breast cancer has been made. This information is very helpful for the
breast surgeon for presurgical planning. Another advantage of MRI is
that there is no radiation.
However, the sensitivity which makes MRI
so successful at identifying cancers causes the identification
of
lesions which may be suggestive of cancer but are benign. These are
called false-positives. Every exam has false-positives including
mammography, ultrasound and physical exam, and these can cause anxiety
for the patient. Because of the experience of our dedicated Breast MRI
doctors, false positive findings are kept to a low level similar to
other imaging studies such as mammography and ultrasound. Importantly,
if an indeterminate or suspicious area is identified on your exam, we
are able to perform a biopsy with MRI guidance using the most advanced
vacuum assisted biopsy machine.
Who
interprets the Breast MRI exam?
At Nassau Radiologic Group (NRAD), we
have a team of board certified radiologists who are specialized with
years of experience in the interpretation of Breast MRI. The team
consists of individuals with fellowship training in MRI and breast
imaging. We were one of the first groups on Long Island to perform
Breast MRI in the 1990's and have lead the way in setting the highest
standard for the performance, interpretation and biopsy capability in
our community. In addition, our Breast MRI practice is part of a
broader full-service breast imaging practice offering digital
mammography, state of the art ultrasound, stereotactic biopsy and
vacuum assisted ultrasound guided capabilities.
When
is the best time to have the Breast MRI exam?
If you are still
menstruating, the best time of the month to have a Breast MRI exam is
7-14 days following the onset of your menstrual cycle in order to
minimize hormonal effects on the breast tissue.
If you are post-menopausal and taking
hormone replacement, we ask that you discontinue the hormones for one
week prior to the exam.
Do
I still need to have mammograms if I have Breast MRI?
Yes.
Mammography remains the primary tool for breast cancer screening.
Breast MRI does not replace mammography.
Why
do I need to bring my prior mammogram, ultrasound and MRI films?
Prior
imaging studies help the doctor to give the most accurate
interpretation of the MRI exam.
Why
do I need an IV?
The
Breast MRI exam is based on evaluating how blood flows into and out of
different types of tissue in the breast. In order to do this, and
intravenous contrast or dye called gadolinium is injected into a vein
through an intravenous catheter. This contrast is well tolerated by
almost all patients. Images are taken in rapid succession both before
and following the administration of contrast, producing hundreds of
images. These images are then evaluated both visually and with special
software programs that evaluate the blood flow. The contrast material
is cleared from your body by your kidneys and excreted into the urine
within 24 hours.
What
is gadolinium?
Gadolinium
is an intravenous contrast or dye which is injected through an
intravenous catheter during the exam. Gadolinium is very safe and well
tolerated by nearly all patients. It is cleared from the blood by the
kidneys and excreted into the urine within 24 hours. There will be no
change in the color of your urine.
How
long is the Breast MRI exam?
You
should expect to be in the office for approximately 1 hour. In most
cases, the actual scanning time is only 30 minutes.
When
do I receive the results of the Breast MRI exam?
Because
hundreds of images are generated during one exam and the complexity of
the computer programs utilized, the results are not immediately
available. You will receive the results of the exam from your
referring physician within a few days.
What
happens if something is seen on MRI but is not seen on mammography or
ultrasound?
If
there is an abnormality on MRI which is indeterminate or suspicious,
and it is not present on mammogram or ultrasound, we can perform a
needle biopsy using MRI guidance
What
are false-positives?
A
false-positive is a finding on an exam which is suggestive of cancer
but which is actually benign. Such a finding can cause a great deal of
stress and anxiety for the patient requiring an interventional
procedure (needle biopsy) for clarification. By using state-of-the-art
equipment to generate our studies which are interpreted by experienced
doctors specialized in Breast MRI interpretation, false-positive
findings are kept to a minimum. In addition, if indeterminate or
suspicious abnormalities are found, we can perform a needle biopsy
with MRI guidance. At Nassau Radiologic Group (NRAD), our years of experience
interpreting thousands of Breast MRI exams in conjunction with an
expert team of traditional interventional breast imagers has enabled
us to provide an extremely beneficial service to our patients and
referring clinicians.
What
is a "targeted", "retrospective", or "second
look" ultrasound?
These
are all terms which refer to an ultrasound recommended on the basis of
a Breast MRI finding. The study is very specifically targeted to the
exact location of the lesion based on the MRI exam for further
evaluation.
Can
I have a Breast MRI if I am pregnant or nursing?
We
do not routinely perform Breast MRI in pregnant or nursing women
because hormonal stimulation of the breast tissue interferes with the
exam.
