Case 55 Answer 2

Answers a, c, and d are generally accepted as indications for MRI:

1. Work-up of extent of disease of a known breast cancer, when the extent is in question on the mammogram or ultrasound, or if the patient is status post lumpectomy with positive margins.

2. Axillary metastases with unknown primary and negative mammogram and ultrasound

3. Evaluate for silicone implant rupture

The indications for MRI are growing, and have been somewhat controversial. Possible other indications for MR:

1. Problem-solving when mammogram and/or ultrasound are indeterminate

2. Screening for high-risk women

Having dense breasts is not an indication for MRI. The cost of screening average risk women with dense breasts would be prohibitive. Perhaps one day when MRI is more affordable this will come into vogue.

What is your assessment after viewing the MRI images?

• Single focus of disease in a background of benign foci of enhancement
• Multifocal disease
• Multicentric disease
• Axillary adenopathy