Home MRI – Magnetic Resonance Imaging MRI Breast with and without Contrast ↓ Download PDF

MRI Breast with and without Contrast

CPT: 77048, 77049

NOTE:

Breast MRI is best performed during days 7 – 14 of a normal 28 day menstrual cycle. Testing in the latter half, luteal phase, of the cycle is subject to increased false positive readings

  • Ellis, Richard L. Optimal Timing of Breast MRI Examinations for Premenopausal Women Who Do Not Have a Normal Menstrual Cycle Am. J. Roentgenol. 2009 193: 1738-1740
  • Breast MRI is NOT to be used to screen asymptomatic patients for breast cancer except as noted in the criteria section. It is not sufficiently accurate to differentiate benign from malignant disease, especially clustered microcalcifications.

1 Breast Cancer Not Currently or Previously Known to be Present

1.1 High genetic risk of breast cancer

1.1.1 Known Gene Mutation associated with >20% lifetime risk of breast cancer

  • 1.1.1.1 ATM (Ataxia-telangiectasia)
  • 1.1.1.2 BRCA1 or BRCA2
  • 1.1.1.3 BARD1
  • 1.1.1.4 CDH1 (Hereditary diffuse gastric cancer)
  • 1.1.1.5 CHEK2
  • 1.1.1.6 NF1 (Neurofibromatosis type 1)
  • 1.1.1.7 PALB2 (Fanconi anemia)
  • 1.1.1.8 PTEN (Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome)
  • 1.1.1.9 RAD51C, RAD51D
  • 1.1.1.10 STK 11 (Peutz-Jeghers syndrome)
  • 1.1.1.11 TP53 (Li-Fraumeni syndrome)

1.1.2 Family history of breast or ovarian cancer in a first degree family member and Ashkenazi (Eastern European) Jewish background

1.1.3 Lifetime Risk of at least 20% according to a Risk Model that is largely dependent on family history (eg, Claus, BRCAPRO, BOADICEA, Tyrer-Cuzick)

1.1.4 First degree Male relative with breast cancer

1.1.5 One first degree relative relative with either 2 breast cancers or both breast and ovarian cancer

1.1.6 Two first degree relatives with breast or ovarian cancer

1.1.7 Relative who is a confirmed carrier of the BRCA1 or BRCA2 gene mutation

1.1.8 LI-FRAUMENI SYNDROME – including first degree relatives

1.1.9 COWDEN SYNDROME – including first degree relatives

1.1.10 BANNAYAN-RILEY-RUVALCABA SYNDROME – including first degree relatives

1.2 Radiation therapy to the chest between the ages of 10-30

1.3 Prior indeterminate breast imaging AND EITHER

  • 1.3.1 Nipple retraction
  • 1.3.2 Unilateral, spontaneous nipple discharge which is bloody or clear and from only 1 or 2 ducts.
  • 1.3.3 Evaluate for a primary occult breast cancer in patients with adenocarcinoma suggestive of breast cancer discovered elsewhere in the body.

1.4 Breast Density

  • 1.4.1 Extremely Dense
  • 1.4.2 Heterogeneously Dense with at least a 15% lifetime risk of breast cancer (Intermediate Risk)

2 Breast Cancer Known to Be Present or Previously Treated

2.1 Newly diagnosed breast cancer to aid in treatment planning

2.2 To evaluate for residual cancer in the recently postoperative patient with positive margins still desiring breast conservation

2.3 After Neoadjuvant treatment for surgical planning purposes.

2.4 Annual screening in a patient with a history of breast cancer (excluding those who have had bilateral mastectomy)

References

  • Saslow D, Boetes C, Burke W, et al, American cancer society guidelines for breast screening with MRI as an adjunct to mammography, CA, A Ca J Clin, 2007; 57(2):75-89.
  • Constance D. Lehman, Wendy DeMartini, Benjamin O. Anderson, and Stephen B. Edge Indications for Breast MRI in the Patient with Newly Diagnosed Breast Cancer J Natl Compr Canc Netw 2009;7:193-201
  • Bassett, Lawrence W., Dhaliwal, Sonia G., Eradat, Jilbert, Khan, Omer, Farria, Dionne F., Brenner, R. James, Sayre, James W. National Trends and Practices in Breast MRI Am. J. Roentgenol. 2008 191: 332-339
  • Louie Enriquez and Jay Listinsky. Role of MRI in breast cancer management Cleveland Clinic Journal of Medicine 2009; 76(9):525-532;
  • Brennan, Sandra, Liberman, Laura, Dershaw, D. David, Morris, Elizabeth Breast MRI Screening of Women With a Personal History of Breast Cancer Am. J. Roentgenol. 2010 195: 510-51 [Interesting article giving preliminary support to screening this group of patients, but lacking evidence of ultimate benefit.]
  • Interpretation and Clinical Applications of Breast MRI: Self-Assessment Module Linda Moy and Cecilia L. Mercado Am. J. Roentgenol., Dec 2008;
  • Loo, Claudette E., Teertstra, H. et al Dynamic Contrast-Enhanced MRI for Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: Initial Results Am. J. Roentgenol. 2008 191: 1331-1338
  • Statement of the American Society of Breast Surgeons accessed at http://www.breastsurgeons.org/statements/PDF_Statements/MRI.pdf > 14 Feb 2012
  • National Comprehensive Cancer Network NCCN Guidelines Breast Cancer Version 2.2012 Accessed 14 Feb 2012
  • Morris E, Bassett LW, Berg WA, et al., ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging (MRI) or the breast accessed at http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/breast/mri_breast.aspx 3/28/11
  • American College of Radiology Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density(revised 2024) https://acsearch.acr.org/docs/3158166/Narrative/
  • Monticciolo DL et al. “Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR”. J Am Coll Radiol 2023; 20:902-914.
  • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Breast Cancer Screening and Diagnosis, Version 1.2019 – May 17, 2019
  • Partridge S, Gibbs J, Yin L, et al. Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR Am J Roentgenol. 2002;179:1193–1199.
  • Chagpar AB, Middleton LP, Sahin AA, et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patientstreated with neoadjuvant chemotherapy. Ann Surg. 2006;243:257–264