Breast MRI acquisition and analysis protocol: a pictorial essay

Breast cancer is a worldwide malignant disease that is heterogeneous in its macroscopic morphology and at the molecular level. Although mammography is the standard examination for diagnosis, breast magnetic resonance imaging (MRI) has the highest sensitivity for breast cancer detection. The indications for a breast MRI are diverse, with cancer staging being the most important. This pictorial essay presents a breast MRI acquisition and analysis protocol, supported by drawings of the morphologic features of mass and non-mass lesions based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) 5th Edition lexicon and the Kaiser score. Our institution includes the following sequences in the breast MRI protocol: T1-weighted spin-echo (SE), T2 fat-suppressed (FS), diffusion-weighted images (DWI), the apparent diffusion coefficient (ADC), T1 gradient echo (GE) with fat sat (FS), T1 dynamic contrast-enhanced (DCE) with gadolinium (Gd), time-signal intensity curve (kinetic curve), positive enhancement integral (PEI) values, maximum intensity projection (MIP) and the coronal T2 fast spin-echo (FSE). Experienced radiologists should interpret breast MRI in correlation with other imaging studies, such as a recent mammography and/or a breast ultrasound. This pictorial essay is published for educational purposes for radiologists and residents.