Is Fast MRI Better Than Mammography?

Kathy D. Miller, MD


August 18, 2014

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This is Dr. Kathy Miller, from Indiana University. I want to draw your attention to a recent edition of the Journal of Clinical Oncology, specifically to an article by Christine Kuhl and associates about fast breast MRI.[1]

Many of you know that I have not been a proponent of breast MRIs. They are simply too costly. They are too sensitive. They see too many things, many of which we don't need to see. There are too many false positives that lead to biopsies and anxiety, and they take too long. MRI is simply not feasible as a screening tool.

Imagine for a minute that you could make breast MRI faster and cheaper, yet maintain the high sensitivity. You would still see the things you need to see but increase the specificity so that you have fewer false positives. That could make this a much better screening technique. Mammograms are as good as they are likely to get, and in some of the more aggressive tumors in our higher-risk patients (younger patients with BRCA mutations, patients with higher breast density), mammograms aren't good enough and we can't make them better. We need something different and better.

Christine Kuhl and colleagues show us a glimpse of that future with their study on fast MRI. How fast is it? Acquisition takes about 3 minutes. How long does it take to read the MRI? It takes from less than 5 seconds for a quick read by the radiologist, and up to 3.5 minutes for a full and thorough read by a radiologist. The cost is estimated to be $400 or less.

This is an initial small study and is not yet ready for primetime. My colleagues at the ECOG Akron Research Group are putting together a multicenter study to look at this fast MRI technique; if this pans out, it might make me, a skeptic, a fan of breast MRI. Check it out.


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