Multiparametric MRI of the breast: A review

Abstract

During their development, cancers acquire several functional capabilities, which are defined as the hallmarks of cancer. For a deeper understanding of the hallmarks of cancer, and, consequently, improved personalized patient care, diagnostic tests must be multilayered and complex to identify the relevant underlying processes of cancer development and progression. In this context, magnetic resonance imaging (MRI) has emerged as an exceptionally powerful, versatile, and precise imaging technique. MRI of the breast is an essential tool in breast imaging, with multiple indications. Dynamic contrast-enhanced MRI (CE-MRI) is the most sensitive test for breast cancer detection, with a good specificity. CE-MRI provides mainly morphological, and, to some extent, functional information about tumor perfusion and vascularity. Recently, several functional imaging techniques in MRI, such as diffusion-weighted imaging and spectroscopy, have been assessed for breast imaging and this combined application is defined as multiparametric imaging. Furthermore, the application of higher field strengths (≥3T) has demonstrated improved sensitivity and specificity of breast cancer detection. Multiparametric imaging with different functional MRI parameters (mpMRI) visualizes and quantifies the functional processes of cancer development and progression at multiple levels, and provides specific information about the hallmarks of cancer. MpMRI of the breast improves diagnostic accuracy in breast cancer, obviates unnecessary breast biopsies, and enables an improved assessment and prediction of response to neoadjuvant therapy. This review will provide a comprehensive overview of the current possibilities and emerging techniques for mpMRI of the breast.

Level of evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:301-315.

Keywords: breast cancer; diffusion-weighted imaging; functional imaging; magnetic resonance imaging; multiparametric imaging; spectroscopy.