A short MRI protocol and a technique called ultrafast MRI parameter time to enhancement (TEE) show promise for finding cancer in BRCA carriers and classifying ductal carcinoma in situ (DCIS), according to research presented November 30 at the RSNA meeting.
In a session that explored the use of advanced MR imaging for breast cancer, presenter Wendelien Sanderink, PhD, of Radboud University Medical Center in Nijmegen, the Netherlands, shared results from a study that found that an abbreviated breast MRI protocol performs comparably to a full one for identifying cancer in women with the BRCA gene mutation.
Sanderink's group conducted a study that included 1,058 women with the BRCA mutation who underwent two screening rounds of breast MRI between January 2012 and December 2024. Of the study cohort, 628 women underwent 1,395 shortened MRI exams (total exam time, 20 minutes) and 755 women underwent 2,750 full-protocol exams (total exam time, 30 minutes).
Sanderink conceded that the recall rate for the abbreviated protocol was higher than that of the full protocol, at 12.6% compared to 9.3%. (Recalls were prompted by BI-RADS results of ≥ 3.) But cancer detection rates were comparable.
"We did see a small but significant higher recall rate with the abbreviated protocol, but nevertheless, difference in cancer detection rates [was not significant]," she told session attendees.
Comparison of full protocol to abbreviated protocol MRI | |||
Measure | Full protocol | Abbreviated protocol | p-value |
| Recall rate | 9.3% | 12.6% | <0.05 |
| Cancer detection rate | 22.7% | 15% | 0.42 |
| Sensitivity | 86% | 96.2% | 0.17 |
| Specificity | 92.4% | 89% | <0.05 |
Sanderink attributed the lower specificity rate to the slightly higher recall rate on abbreviated MRI. She also noted that her team found no significant differences in tumor diameter or lymph node positive lesions between the two approaches.
The results suggest that "abbreviated MRI can be a time-efficient and resource-saving alternative for high-risk breast cancer screening without compromising diagnostic performance," she concluded.
In a related presentation, Carla Sitges, MD, of the Hospital Clínic Barcelona in Spain, shared research that found that incorporating ultrafast MRI parameter time to enhancement, or TTE, data into breast MRI exams improves the classification of DCIS -- which could translate to less treatment intensity and allow for more tailored care.
Sitges noted that although identifying DCIS can help clinicians efforts to prevent invasive breast cancer, in cases of lower-grade disease, it can lead to overtreatment. She explained that classifying DCIS via imaging techniques could identify cases with "biological significance and distinguish them from indolent ones that might benefit from surveillance and avoid standard treatment.
The investigators conducted a study that included 160 women diagnosed with DCIS who underwent ultrafast MRI. They classified DCIS grade on a scale of one to three (low, intermediate, and high risk of recurrence).
She noted that as the lesions became more aggressive, they shifted toward shorter enhancing times:
- DCIS grade 1 (low): TTE 13.05 seconds
- DCIS grade 2 (intermediate): 11.52 seconds
- DCIS grade 3 (high): 9.68 seconds
- Invasive inflammatory breast cancer (IBC): 8.41 seconds
Sitges concluded that integrating the ultrafast MRI parameter TTE into clinical practice could "enhance DCIS risk stratification, support treatment deescalation, and allow for more personalized management."
