Abbreviated MRI protocols could dramatically improve the diagnosis of breast cancer and lead to the earlier diagnosis of a lot more women, especially those with fast-growing cancers, according to an ongoing large-scale phase 2 EA1141 study.
"Mammograms detect slow-growing cancers but, notoriously, deliver false negatives for rapid-growing cancers," said Christiane Kuhl, from the University of Aachen in Germany.
Traditionally, MRI has only been used to characterize cancer, to map known disease. "But we are seeing that it's by far the most accurate imaging method for diagnosis," she added.
She and her colleagues are conducting the ongoing large-scale phase 2 EA1141 trial to investigate the utility of abbreviated MRI for screening in 1450 women with dense breast tissue who are at average risk for breast cancer.
Host-related factors, such as breast tissue density, and tumor-related factors contribute to the failure of mammographic screening to detect biologically relevant breast cancer.
A typical MRI study takes up to 40 minutes and generates several hundred images. An abbreviated MRI has a 3-minute magnet time and an abridged image interpretation time (about 30 seconds),
It generates only one precontrast and one postcontrast T1 weighted image set, and uses maximum-intensity projections to fuse the first postcontrast subtracted images into one single high-contrast image.
In an early study, the diagnostic accuracy of abbreviated breast MRI was shown by Dr. Kuhl's team to be equivalent to that of a diagnostic protocol that took 17 minutes.
In a more recent study, the team showed that MRI screening improves the early diagnosis of prognostically relevant breast cancer in women at average risk for breast cancer.
Currently, there are about 16 publications that confirm that abbreviated MRI is the best way to detect breast cancer, Dr. Kuhl reported. It is generally agreed, however, that "it's way too expensive."
Fast MRI protocols can also improve the diagnosis of conditions other than breast cancer. Dr. Kuhl's group recently showed that abbreviated bi-parametric MRI improved the detection of clinically significant prostate cancer in men with elevated levels of prostate-specific antigen.
And in a study also presented at the RSNA meeting, a 5-minute MRI protocol was as accurate as standard knee MRI for the evaluation of internal derangement of the knee.
"The two were diagnostically interchangeable, particularly for our patients who have claustrophobia or pain," said Erin Alaia, assistant professor of radiology at NYU Langone Health in New York City.
For their study, Dr. Alaia and her colleagues assessed 146 patients who underwent MRI. Of the 146 patients, 100 underwent 3T MRI (100 scans) and 46 underwent 1.5T MRI (50 scans).
Four musculoskeletal radiologists evaluated menisci, ligaments, cartilage, and bone, and compared five fast multiplanar 2D FSE sequences using parallel imaging with 5 standard sequences. "We compared and saw the same results," Dr. Alaia reported.
"We just need to get the image quality that's necessary for the diagnosis," said her colleague Naveen Subhas, associate professor of radiology at the Cleveland Clinic. "That's going to take some time for a lot of people to get their heads around."