title: Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection?
abstract: OBJECTIVE
  To evaluate the ability of an abbreviated breast magnetic resonance imaging (MRI) protocol, consisting of a precontrast T1 weighted (T1W) image and single early post-contrast T1W image, to detect breast carcinoma.
  
  
  METHODS
  A HIPAA compliant Institutional Review Board approved review of 100 consecutive breast MRI examinations in patients with biopsy proven unicentric breast carcinoma. 79% were invasive carcinomas and 21% were ductal carcinoma in situ. Four experienced breast radiologists, blinded to carcinoma location, history and prior examinations, assessed the abbreviated protocol evaluating only the first post-contrast T1W image, post-processed subtracted first post-contrast and subtraction maximum intensity projection images. Detection and localization of tumor were compared to the standard full diagnostic examination consisting of 13 pre-contrast, post-contrast and post-processed sequences.
  
  
  RESULTS
  All 100 cancers were visualized on initial reading of the abbreviated protocol by at least one reader. The mean sensitivity for each sequence was 96% for the first post-contrast sequence, 96% for the first post-contrast subtraction sequence and 93% for the subtraction MIP sequence. Within each sequence, there was no significant difference between the sensitivities among the 4 readers (p=0.471, p=0.656, p=0.139). Mean interpretation time was 44s (range 11-167s). The abbreviated imaging protocol could be performed in approximately 10-15 min, compared to 30-40 min for the standard protocol.
  
  
  CONCLUSIONS
  An abbreviated breast MRI protocol allows detection of breast carcinoma. One pre and post-contrast T1W sequence may be adequate for detecting breast carcinoma. These results support the possibility of refining breast MRI screening protocols.
authors.affiliation: Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, New York, NY 10032, United States; Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: vlm2125@columbia.edu.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Mango
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: morrise@mskcc.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: dershawd@mskcc.org.
authors.forename: D
authors.initials: D
authors.lastname: David Dershaw
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: abramsoa@mskcc.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Abramson
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States; New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States. Electronic address: charles_fry@nymc.edu.
authors.forename: Charles
authors.initials: C
authors.lastname: Fry
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States.
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: hughesm@mskcc.org.
authors.forename: Mary
authors.initials: M
authors.lastname: Hughes
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: kaplanj@mskcc.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kaplan
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065, United States. Electronic address: jochelsm@mskcc.org.
authors.forename: Maxine S
authors.initials: MS
authors.lastname: Jochelson
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Abbreviated MRI protocol; Breast MRI; Breast cancer screening