Magnetic resonance imaging (MRI) is a powerful tool for the identification and staging of primary breast cancer. It performs especially well when used for specific indications such as breast cancer screening in a high-risk population, staging of ipsilateral breast cancer and concurrent screening for contralateral breast cancer in women diagnosed with breast cancer, monitoring of response to neoadjuvant chemotherapy, and evaluating patients with axillary metastasis from an unknown primary. Coupled with experienced breast MRI readers and ready access to image-guided biopsy, MRI is a highly sensitive technique for identifying breast cancer. Advances in dynamic contrast-enhanced (DCE) breast MRI within the past decade have led to significant improvements in the detection of early breast cancer, and higher accuracy in the detection of multifocal and multicentric disease. This has resulted in increased applications of breast MRI in the diagnosis and management of breast cancer on a global level. Nonetheless, the true role of DCE breast MRI in the management of breast cancer patients remains controversial, as there is limited data establishing its benefits when using outcome parameters of recurrence and survival.
Accuracy of breast MRI relies on the following factors: adequate technique, use of established image interpretation criteria [American College of Radiology Breast Imaging and Reporting Data System (ACR BI-RADS®) MRI lexicon and reporting system], and patient selection. To obtain maximum performance from breast MRI studies, we present basic technical requirements for breast MRI, along with illustrated, well-established clinical applications and MRI-guided intervention techniques. We also discuss some of the controversies surrounding breast MRI regarding the evaluation of early breast cancer, preoperative staging of breast cancer (it might not be for all women), and the suggested management of suspicious lesions (ACR BI-RADS® 4 and 5) identified by MRI.