Shortened protocols could cut costs, improve access to breast MRI

It may be possible to shorten breast MRI protocols and give more patients access to the modality’s benefits, according to a study published in Academic Radiology.

Lars J. Grimm, MD, of the Duke University Medical Center department of radiology, and colleagues recognized that breast MRI has been shown repeatedly to have the highest sensitivity of all imaging modalities when screening for breast cancer, regardless of breast density.

However, the authors wrote, the use of breast MRI as a screen tool is limited by numerous factors, including high costs, study length, and the need for intravenous contrast. So Grimm et al. explored a possible solution to this conundrum: shorten and simplify the breast MRI protocol.

“The multiple sequences used in a standard breast MRI lead to long scan acquisition times and subsequent long interpretation times, both of which impact the cost of breast MRI,” the authors wrote. “Theoretically, the cost of breast MRI could be reduced if the time for both acquiring and interpreting was decreased.”

The authors developed two shortened breast MRI protocols for analysis in a pilot study. The first, which they called “abbreviated 1,” included three sequences: T2-weighted, dynamic pre-contrast, and first pass dynamic post-contrast sequence. The second, “abbreviated 2,”  took those same three sequences and added a second pass dynamic post-contrast sequence.

Three radiologists with at least seven years of experience participated in the study, assessing 48 cases based on the first shortened protocol and then the second. After at least one month, the radiologists were then asked to look at the case following the full protocol, which included additional dynamic post-contrast sequences and a nonfat-saturated T1-weighted sequence

The radiologists’ assessments for each protocol were then compared, and there was “no significant difference” in sensitivity or specificity between the shortened protocols and the full protocol.

Abbreviated 1 resulted in an overall sensitivity 86 percent, with a specificity of 52 percent. Abbreviated 2 resulted in an overall sensitivity 89 percent, with a specificity of 45 percent. The full protocol, not shortened at all, produced a sensitivity of 95 percent and a specificity of 52 percent.

“The results of this pilot study contribute to the growing body of data that suggest that shortened breast MRI protocols may become a viable clinical option for screening,” the authors wrote.

According to the authors, these shortened protocols could lower costs associated with breast MRI screening and increase its availability. Considering the results seen from breast MRI compared to other modalities, the authors touted the potential for this to especially benefit women with dense breast tissue.