Breast Cancer Screening
Savannah Partridge1

1University of Washington, United States


Abbreviated breast MRI protocols hold potential to reduce time and overall costs of breast MRI examinations, which could increase accessibility for more widespread screening. A growing number of studies have demonstrated that abbreviated MRI protocols can provide comparable diagnostic accuracy to that of conventional full MRI protocols for breast cancer screening. Current approaches and performance results will be reviewed, along with discussion of future directions.


  • Discuss potential role for abbreviated protocols in breast imaging
  • Review varying approaches and performance results for abbreviated breast MR protocols
  • Discuss the ongoing ECOG-ACRIN EA1141 prospective multicenter trial of abbreviated breast MRI and future directions


Results of large screening trials have established breast MRI to be the most sensitive technique for detecting breast cancer [1-3]. It is currently recommended for screening of women with high lifetime risk (>20%) [4]. However, the lengthy scan times and associated high costs of conventional comprehensive breast MRI examinations limit accessibility of this screening tool for many women and reduce feasibility for expanded use in intermediate or lower risk cohorts who would benefit from supplemental breast MRI screening, such as women with elevated breast density. Initially demonstrated by Kuhl et al in 2014 [5], abbreviated breast MRI protocols have shown promise for increasing the efficiency and cost-effectiveness of breast screening by dramatically reducing scan and interpretation times. Advanced acquisition techniques may further improve diagnostic performance of abbreviated breast MRI protocols [6].


Conventional breast MRI protocols vary but typically consist of multiple sequences including a localizer, water-sensitive sequence (T2-weighted and/or STIR) and dynamic series of T1-weighted pre- and post-contrast scans, and also may include other sequences such as non-fat-suppressed T1-weighted and diffusion-weighted imaging (DWI) sequences. Abbreviated breast MRI protocols also vary considerably across studies in the literature [7-20]. The common goal is to increase throughput by reducing overall scan time to ~10 minutes or less. Most frequently this is achieved by obtaining at minimum a pre-contrast and single post-contrast T1-weighted acquisition, critical for retaining sensitivity, and eliminating extra post-contrast T1-weighted acquisitions and any other non-essential sequences. Without the additional post-contrast T1-weighted sequences, typical abbreviated protocols only allow for assessment of morphology of enhancing lesions but not kinetics, which can be helpful for differential diagnosis [21]. Novel ‘ultrafast’ dynamic contrast-enhanced (DCE) MRI protocols are being explored to extract valuable early kinetic information within the shortened time window of abbreviated MR [22-24]. These techniques use accelerated imaging strategies to provide both high spatial and high temporal resolution, which could allow optimal evaluation of both the morphologic characteristics and kinetics of lesions.


There have been studies from several institutions investigating the performance of abbreviated MRI protocols for breast cancer screening. For the most part, their findings have been in agreement, demonstrating that abbreviated breast MRI provides comparable diagnostic accuracy to full diagnostic protocols. Across all studies, abbreviated protocols had substantially shorter acquisition times (average, 8 minutes) compared with the full diagnostic protocols (average, 25 minutes). In studies that compared performance of abbreviated versus full diagnostic protocols, the shorter acquisition time and faster interpretation did not significantly affect sensitivity (ranging 88–100%) or [5, 7, 11, 12, 14-17, 20]. Most studies also found no difference in specificity using abbreviated protocols, although lower specificity was reported in one study (88% for abbreviated vs. 95% for the full protocol, p=0.036) [12]. Multiple ultrafast DCE-MRI studies have reported the early kinetics metrics including maximum relative enhancement slope and time to enhancement to be valuable kinetics metrics for discriminating benign and malignant enhancing breast lesions [22-25]. One study using an abbreviated breast MRI protocol found ultrafast DCE-MRI to improve the specificity (averaged for two readers) from 60% to 77%, which was also higher than the specificity achieved using a full protocol (59%) [14]. This higher specificity was achieved without any decrease in sensitivity (93% for abbreviated MRI with and without ultrafast DCE-MRI and also for the full protocol).


Abbreviated breast MRI protocols hold potential to increase throughput and reduce overall costs of breast MRI, which could increase accessibility for more widespread screening. A growing number of studies have demonstrated that abbreviated MRI protocols can provide comparable diagnostic accuracy to that of the conventional full MRI protocol at reduced scan and interpretation times. Additionally, preliminary investigations of abbreviated MRI protocols incorporating ultrafast DCE-MRI sequences show promise for obtaining diagnostically useful kinetic information within the shortened imaging timeframe. In future directions, these promising and mostly concordant results of single-center studies have prompted a multicenter trial currently underway to investigate the utility of abbreviated breast MRI as a low cost supplemental screening test for females with dense breast tissue (ECOG-ACRIN EA1141) [26, 27]. Also, emerging research on non-contrast/unenhanced methods, relying primarily on diffusion-weighted imaging (DWI) for cancer detection, may also hold potential to further eliminate the associated time, costs and toxicities of gadolinium administration in abbreviated breast MR protocols. As growing evidence and results of multicenter trials confirm the accuracy to be comparable to that of conventional breast MRI protocols, it is likely that abbreviated MRI protocols will quickly become the standard approach for breast MRI screening and may increase feasibility for screening a wider population of women with intermediate or lower risk.


Funding support: NIH/NCI R01CA207290


  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 2012; 307(13): p. 1394-1404.
  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 2004; 351(5): p. 427-437.
  3. 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): p. 1295-1303.
  4. 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): p. 75-89.
  5. Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, and 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; 32(22): p. 2304-2310.
  6. Chhor CM and Mercado CL. Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening. AJR Am J Roentgenol 2017; 208(2): p. 284-289.
  7. Grimm LJ, Soo MS, Yoon S, Kim C, Ghate SV, and Johnson KS. Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol 2015; 22(9): p. 1157-1162.
  8. Mango VL, Morris EA, David Dershaw D, et al. Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection? Eur J Radiol 2015; 84(1): p. 65-70.
  9. Harvey SC, Di Carlo PA, Lee B, Obadina E, Sippo D, and Mullen L. An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources. J Am Coll Radiol 2016; 13(11S): p. R74-R80.
  10. Heacock L, Melsaether AN, Heller SL, et al. Evaluation of a known breast cancer using an abbreviated breast MRI protocol: Correlation of imaging characteristics and pathology with lesion detection and conspicuity. Eur J Radiol 2016; 85(4): p. 815-823.
  11. Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, and Angelelli G. Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions. Clin Breast Cancer 2016; 16(3): p. 207-211.
  12. Chen SQ, Huang M, Shen YY, Liu CL, and Xu CX. Abbreviated MRI Protocols for Detecting Breast Cancer in Women with Dense Breasts. Korean J Radiol 2017; 18(3): p. 470-475.
  13. Machida Y, Shimauchi A, Kanemaki Y, Igarashi T, Harada M, and Fukuma E. Feasibility and potential limitations of abbreviated breast MRI: an observer study using an enriched cohort. Breast Cancer 2017; 24(3): p. 411-419.
  14. Oldrini G, Fedida B, Poujol J, et al. Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization. Eur J Radiol 2017; 95: p. 177-185.
  15. Panigrahi B, Mullen L, Falomo E, Panigrahi B, and Harvey S. An Abbreviated Protocol for High-risk Screening Breast Magnetic Resonance Imaging: Impact on Performance Metrics and BI-RADS Assessment. Acad Radiol 2017; 24(9): p. 1132-1138.
  16. Petrillo A, Fusco R, Sansone M, et al. Abbreviated breast dynamic contrast-enhanced MR imaging for lesion detection and characterization: the experience of an Italian oncologic center. Breast Cancer Res Treat 2017; 164(2): p. 401-410.
  17. Romeo V, Cuocolo R, Liuzzi R, et al. Preliminary Results of a Simplified Breast MRI Protocol to Characterize Breast Lesions: Comparison with a Full Diagnostic Protocol and a Review of the Current Literature. Acad Radiol 2017; 24(11): p. 1387-1394.
  18. Strahle DA, Pathak DR, Sierra A, Saha S, Strahle C, and Devisetty K. Systematic development of an abbreviated protocol for screening breast magnetic resonance imaging. Breast Cancer Res Treat 2017; 162(2): p. 283-295.
  19. Choi BH, Choi N, Kim MY, Yang JH, Yoo YB, and Jung HK. Usefulness of abbreviated breast MRI screening for women with a history of breast cancer surgery. Breast Cancer Res Treat 2018; 167(2): p. 495-502.
  20. Oldrini G, Derraz I, Salleron J, Marchal F, and Henrot P. Impact of an abbreviated protocol for breast MRI in diagnostic accuracy. Diagn Interv Radiol 2018; 24(1): p. 12-16.
  21. Morris EA, Comstock CE, and Lee CH, et al, ACR BI-RADS® Magnetic Resonance Imaging, in In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System2013, American College of Radiology: Reston, VA.
  22. Abe H, Mori N, Tsuchiya K, et al. Kinetic Analysis of Benign and Malignant Breast Lesions With Ultrafast Dynamic Contrast-Enhanced MRI: Comparison With Standard Kinetic Assessment. AJR Am J Roentgenol 2016; 207(5): p. 1159-1166.
  23. Mann RM, Mus RD, van Zelst J, Geppert C, Karssemeijer N, and Platel B. A novel approach to contrast-enhanced breast magnetic resonance imaging for screening: high-resolution ultrafast dynamic imaging. Invest Radiol 2014; 49(9): p. 579-585.
  24. Pineda FD, Medved M, Wang S, et al. Ultrafast Bilateral DCE-MRI of the Breast with Conventional Fourier Sampling: Preliminary Evaluation of Semi-quantitative Analysis. Acad Radiol 2016; 23(9): p. 1137-1144.
  25. Mus RD, Borelli C, Bult P, et al. Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions. Eur J Radiol 2017; 89: p. 90-96.
  26. Kuhl CK. Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol 2017.
  27. EA1141: Abbreviated Breast MRI and Digital Tomosynthesis Mammography in Screening Women With Dense Breasts. Eastern Cooperative Oncology Group (ECOG)-American College of Radiology Imaging Network (ACRIN). Last accessed April 4, 2018.
Proc. Intl. Soc. Mag. Reson. Med. 26 (2018)