Breast Cancer Protocol: The Basics
What we do (See Technical Parameters for details)
| Sequence | Reason | Uni/bilateral |
| Sagittal T2W FSE, TE 100 TR 5000 | Cancer often hypointense compared to fat | Symptomatic side |
| Sagittal T2W FSE, fat sat, TE 80 TR 5000 | Cancer variable, can be hyperintense to fat and breast parenchyma | Symptomatic side |
| Axial T1W FSE, TE min TR 500 | Anatomy and lesion characterization | Symptomatic side |
| Pre and dynamic (20s, 3 min, 6 min) sagittal T1W FSPGR fat sat, 1.5 dose gadolinium at 2cc/sec with 20cc saline flush | Lesion identification and dynamic enhancement characteristics | Always bilateral |
| Post gadolinium axial T1W FSPGR, fat sat | Lesion localization in a second plane | Always bilateral |
| Post processing: Subtraction of first and third enhanced phases | Lesion identification | Always bilateral |
| Post processing: Region of interest (ROI) dynamic enhancement curves | Lesion characterization | ROI |
Controversies
Dynamic enhancement of both breasts vs. symptomatic breast only - Imaging both breasts provides an internal control for the symptomatic breast - Evaluates for multifocal disease
High spatial resolution vs. speed during the enhancement phase - We use a medium resolution, 2D FSPGR sequence that allows for fast dynamic imaging of both breasts concurrently in the sagittal plane - 3D high resolution protocols have less volume averaging but breasts must be imaged separately
Image both breasts during the same appointment vs. patient returning on separate days - No variation in breast tissue due to menstrual cycle - A single visit is easier to schedule
Gadolinium dose - No agreed upon optimal dose
Multiphasic gadolinium enhancement vs. single post gadolinium sequence - Enhancement characteristics can be helpful in diagnosis