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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EMammograms are said to detect 80% to 85% of all breast cancers. Women with densities in at least 65% of their breasts are estimated to have a 4- to 6-fold increased risk of breast cancer when compared to women with less dense breasts. Innovations in magnetic resonance imaging (MRI) and computer technology have led to improved scanning strategies, transmission characteristics, and image resolution, as discussed in this article.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emagnetic resonance imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebreast cancer\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EMammograms are said to detect 80% to 85% of all breast cancers. According to speaker David A. Strahle, MD, Regional Medical Imaging, Flint, Michigan, USA, mammograms \u201ceventually\u201d pick up 80% to 85% of all breast cancers, after accounting for women with dense breasts, whose cancers are often missed on the initial and often subsequent mammograms\u2014a delay that could change the course of the disease. Women with densities in at least 65% of their breasts are estimated to have a 4- to 6-fold increased risk of breast cancer when compared to women with less dense breasts [Ginsburg OM et al. \u003Cem\u003EBr J Cancer.\u003C\/em\u003E 2008]. Approximately one-half to three-quarters of all women in their 40s and 50s may have a breast density \u2265 50% [Checka CM et al. \u003Cem\u003EAJR Am J Roentgenol.\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EInnovations in magnetic resonance imaging (MRI) and computer technology have led to improved scanning strategies, transmission characteristics, and image resolution. As tumors grow, they develop a neovascular network necessary for invasion and metastasis. Once a tumor develops these abnormal vessels, it becomes detectable by MRI down to about 3 mm.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDr Strahle and his team designed a protocol to evaluate the role that dense fibroglandular tissue (FGT) plays in obscuring breast cancer, and they explored the feasibility of using a limited number of MRI sequences for a national screening program. From 2009 to 2011, 671 random average-risk women with negative screening mammograms were offered free breast-screening MRI. Seventeen parameters were recorded, including percentage volume of FGT, brightness of the FGT density, and location of any lesions inside or outside of FGT. Simplified reading criteria were developed to standardize interpretation so that an average MRI reader in clinical practice could quickly interpret the images.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EIn 208 of the 671 women, 315 abnormalities not seen on the screening mammogram were detected with MRI. Of these, 7 masses were identified as malignant by MRI and confirmed on biopsy as 1 invasive lobular carcinoma, 3 invasive ductal carcinomas, and 3 ductal carcinoma in situ (DCIS) lesions. All of the cancers were hidden within FGT occupying \u2265 50% of the breast volume. All of the cancers were detected with only 2 MRI sequences (4 acquisitions), requiring only 7.5 minutes of scan time. According to Dr Strahle, this rapid MRI screening protocol reduced the MRI cost by \u0026gt; 50%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ERapid MRI had a 57% false-positive biopsy rate, with a reduction of 50% in the number of biopsies and a positive predictive value of 41%. Additionally, 364 of the mammographic Breast Imaging Reporting and Data System (BI-RADS) codes were changed, as one-half of the recorded mammographic BI-RADS codes were in error.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ECurrent data suggest that screening mammograms detect 2.7 cancers per 1000 women per year in the general population [Arleo EK et al. \u003Cem\u003EAHR Am J Roentgenol.\u003C\/em\u003E 2013]. By adding MRI to the mammogram in women with \u2265 50% FGT, Dr Strahle and his group detected additional cancers at a rate of 16.3 per 1000 women per year. With a screening-mammogram detection rate of 2.7, it could take up to 6 years to eventually identify all 16.3 cancers found on MRI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EHe then went on to speak about microcalcifications of the breast, which occasionally develop in the presence of a few small, slow-growing cancers and are often picked up on a mammogram. Many of these microcalcifications are not visible on MRI, because they have not yet developed the neovasculature needed for identification by MRI. For this reason, the American College of Radiology guidelines have determined that mammography is the most appropriate radiologic procedure for women with breast microcalcifications [Comstock CH et al. \u003Cem\u003ENational Guideline Clearinghouse.\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EBecause DCIS is characterized by microcalcifications in the affected milk ducts, conventional wisdom has held that MRI was unsuited for detecting this early stage of breast cancer. However, data suggest that the sensitivity of MRI for detecting DCIS is actually much higher than that of mammography [Kuhl CK et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2007]. This may be due to the fact that fast-growing DCIS lesions do not always develop microcalcifications. Instead, high-grade DCIS appears to be pervaded by many small blood vessels that are clearly visible on MRI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ECurrently, breast MRI is used only after a mammogram has initially detected an abnormality, which, according to Dr Strahle, \u201cseverely limits MRI\u0027s ability to change the course of the disease.\u201d He believes that after identification of tumors both small and large during the first year of a national MRI screening program, subsequent years of screening will result in identification of smaller and smaller tumors, further reducing the need for chemotherapy and radiotherapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EIn September 2012, Dr Strahle\u0027s practice began using the rapid MRI protocol for women with dense breasts. In the last 2 years, 1 cancer has been found for every 344 women screened by mammography and 1 cancer for every 60 women screened by MRI. A comparison of reimbursement in the practice found that the additional cost of screening MRI per woman was US$72, adding only a 28% increase to the total mammography budget. Screening MRI helps to avoid the costs associated with late identification and treatment. According to Dr Strahle, the total dollar savings are high enough to absorb the cost of both mammograms and MRI while yielding a significant net savings. Based on these data, at least 1 insurance carrier in Michigan has agreed to reimburse for routine breast-screening MRI using the rapid protocol.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003ECurrently, breast tomosynthesis and automated 3D breast ultrasound are being marketed at substantially increased cost, but both may require added mammogram views and unnecessary biopsies as well. \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E compares the detection rates of several screening technologies.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Breast Cancer Detection Rate per 1000 Women\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1623180346\u0022 data-figure-caption=\u0022Breast Cancer Detection Rate per 1000 Women\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16495\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EBreast Cancer Detection Rate per 1000 Women\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EMRI, magnetic resonance imaging.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from DA Strahle, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EDr Strahle concluded that while mammography should remain the standard of care for women with \u0026lt; 50% FGT, MRI should be used in place of, or in addition to, mammography for screening women with dense breasts \u0026gt; 50% FGT. He estimates that with 35% unused capacity in radiology facilities throughout the United States, at least two-thirds of women with dense breasts could undergo MRI scanning without additional facility costs or the purchase of any new technology.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1623180346\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/53\/4\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16407\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EThe editors would like to thank the many members of the Radiological Society of North America 100th Scientific Assembly and Annual Meeting presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}