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Breast magnetic resonance imaging (MRI) has attained a solid position in the evaluation of the breast, and many believe it is currently a necessary component of any breast imaging practice. In the past decade, many advances have contributed to the more routine use of this robust tool for cancer detection, including newer faster imaging sequences with improved image quality as well as new biopsy equipment that allows percutaneous needle biopsy of suspicious lesions. Additionally, societies have created guidelines for breast MRI, thus improving standardization in the performance, interpretation, and recommended use of this technology. Many of our current algorithms in the detection and treatment of breast cancer have been changed by the availability of breast MRI.
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Clinical indications for breast MRI1 include screening for breast cancer in the high-risk patient (Fig. 35-1), assessing response to chemotherapy in the patient with known breast cancer undergoing new-adjuvant chemotherapy (Fig. 35-2), assessing residual disease in a conserved breast with positive margins (Fig. 35-3), assessing possible recurrence in the treated breast when there is clinical or imaging suspicion (Fig. 35-4), screening the contralateral breast in the patient with known breast cancer (Fig. 35-5), and assessing for underlying cancer in a patient with occult primary breast cancer (Fig. 35-6). Breast MRI can also be valuable in the evaluation of inconclusive findings on conventional imaging (Fig. 35-7). The final clinical indication where MRI may be helpful but where there is less clinical evidence is assessing extent of disease in the preoperative setting (Fig. 35-8).
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