Is Ultrafast or Abbreviated Breast MRI Ready for Prime Time?

Breast MRI has been recognized as the most sensitive modality for breast cancer screening. Its use is, however, restricted due to the high costs of the MRI scan itself, the limited availability of MRI scanners and the long reading times. In this review, the use of shorter MRI protocols for screening is discussed. Shortened scan protocols have been proposed to reduce both the actual patient handling time and the time to evaluate the scan. So far, these “abbreviated” scan protocols have shown similar sensitivity and only marginally lower specificity as the common scan protocols, while largely reducing scan time and time required for evaluation. To retain the dynamic information, ultrafast dynamic breast MRI was introduced, capturing the inflow of contrast in a lesion. This comes for free in terms of scan time. The diagnostic information from this dynamic evaluation is even stronger than the conventional curve types and can be exceptionally helpful in the evaluation of small lesions. Since abbreviated and ultrafast MRIs are not mutually exclusive, both techniques can be combined, yielding a screening protocol with a scan time below 5 min. However, only very few studies evaluated these protocols in a true screening setting, and the number of detected cancers is likewise very low. Abbreviated protocols with ultrafast MRI allow shortening of breast MRI for screening while retaining excellent sensitivity and specificity. Prospective study data are however limited and must be further substantiated.