Breast MRI: Current challenges and future directions

While mammography and ultrasonography remain the mainstay of breast imaging, it is well recognised that each has limitations, most notably the reduced sensitivity of mammography in the dense breast, and the limited specificity of ultrasound, especially in the screening setting. Magnetic resonance imaging (MRI) of the breast is the most sensitive imaging modality for detection and local staging of breast cancer. The sensitivity of dynamic contrast-enhanced breast MRI (DCE-MRI) for invasive cancers is greater than 95% in most series. It is the most accurate technique for assessment of tumour size and multifocality and is reported to be better than mammography at detection of ductal carcinoma in situ (DCIS), especially high grade DCIS. Accurate assessment of disease extent is essential in determining the most appropriate treatment for individual patients, specifically whether breast conserving surgery is possible with or without some form of neoadjuvant medical therapy.

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