Kathleen R. Gundry, MD

Contrast-enhanced breast magnetic resonance imaging (MRI) is arelatively new but increasingly used modality for the detection of breastcancer. MRI has demonstrated utility in identifying additional tumorfoci and extent of disease in patients with known breast cancer. This isespecially useful with invasive lobular carcinoma, which is difficult toevaluate on mammography. MRI has been found to identify the primarytumor in 70% to 86% of cases of occult breast cancer. Contrastenhancedbreast MRI has shown some usefulness in the detection ofresidual cancer following surgery but is limited by postoperative changes.In patients who have undergone neoadjuvant chemotherapy, breast MRIis most accurate in those patients in whom there is little or no responseto chemotherapy. The use of contrast-enhanced breast MRI for breastcancer screening is controversial. It has only been used in a few smallstudies of high-risk patients. The limitations of breast MRI includeuptake in benign lesions and normal tissue, sensitivity for ductal carcinomain situ, cost, and availability. This paper will discuss the uses,benefits, and limitations of contrast-enhanced breast MRI in the stagingand screening of breast cancer.