Abbreviated MRI Performs Well in Women with BRCA Mutations

Abbreviated MRI showed cancer detection rates comparable to a full MRI protocol in women with BRCA gene mutations, according to a new Dutch study presented Sunday morning.

“Multiple hospitals in the world are already using an abbreviated protocol for MRI breast screening,” said Wendelien Sanderink, a technical physician at Radboud University Medical Center in Nijmegen, the Netherlands. “We wanted to assess the diagnostic accuracy of our new abbreviated breast MRI protocol compared to a full diagnostic breast MRI protocol for a select group of high-risk women.”

Before 2020, the medical center used a full breast MRI screening protocol with an 18-minute acquisition time. This protocol included several imaging steps: diffusion-weighted imaging (DWI), one pre- and four post-contrast T1-weighted images, an ultrafast T1 during the contrast inflow, and a T2-weighted acquisition at the end. 

Starting in April 2020, the center adopted a new, abbreviated MRI protocol. The new approach uses DWI, one pre-contrast and one post-contrast T1-weighted image, plus an ultrafast T1 sequence during contrast inflow. The shorter protocol reduces the scan time to just 8 minutes. “The abbreviated protocol saves us approximately 10 minutes per patient and allows us to scan three patients an hour instead of two,” Sanderink said.

Protocols Show Comparable Detection, Specificity and Sensitivity

The Dutch National Breast Cancer Screening Programme offers women between the ages of 50 and 75 a screening mammogram every two years. However, women who have a high risk of breast cancer are eligible for more frequent screening. They can receive a yearly MRI between the ages of 25-40, both a yearly mammogram and MRI from ages 40 and 60, and a biannual mammogram after age 60. Women at high-risk are defined as having a family history of breast cancer, having been exposed to radiation as a child, or being a carrier of a genetic mutation. 

In the study, Sanderink and colleagues compared the results of BRCA1/2 carriers screened using a full MRI protocol between 2012 and 2020 with those screened using the abbreviated protocol between 2020 and 2024. The cohort included 755 women imaged with the full protocol and 628 women imaged with the abbreviated protocol. The mean age of the subjects was 40.5 and 39.8, respectively. 

According to the findings, there were no significant differences between the two protocols in the cancer detection rates or sensitivity. A small but significant increase in the recall rate for the abbreviated protocol (12.6% vs. 9.3%) was associated with slightly reduced specificity compared to the full protocol (92.4% vs. 89%).

“When you change to an abbreviated protocol, it’s typical for rates to go up a little bit as radiologists learn to work with and trust the new protocol,” Sanderink explained. “We’ll watch to see how this rate changes over the years.”

The number and characteristics of the cancers found using both protocols were also similar. “We didn’t see any difference in tumor diameter and lymph node positivity between the two protocols,” she said. “If anything, the cancers detected with the abbreviated protocol are even smaller than those detected with the full protocol.” 

Sanderink said she considered the 96.2% sensitivity rate for the abbreviated protocol versus 86% for the full protocol to be the most significant finding of the study. “We don’t want to be missing cancers,” she said. “Our findings demonstrate that the abbreviated protocol is as good as the full protocol and it’s safe to use.”

Access the session, “Diagnostic Performance of Abbreviated Vs. Full Breast MRI Protocols in BRCA Mutation Carriers,” (S2-SSBR01-1) on demand at RSNA.org/MeetingCentral