Breast MRI. The potentials and dangers: are you informed?

Breast MRI is a field that is rapidly emerging. The approaches to breast MRI technology and clinical utilization are highly variable. The viability of any selected technology should be fully understood before it is advocated as a solution for any clinical role. It is my opinion that all breast MR methods currently in use should undergo more clinical trials before they are employed for routine breast diagnosis. Before purchasing special breast imaging hardware, you should be shown proof of clinical capability that includes well controlled clinical trials, not just a pretty picture. The use of MRI for breast diagnosis is far different from other clinical applications. If MRI misses the meniscal tear, the patient will return with continued symptoms and eventually have appropriate treatment. If MRI falsely calls a meniscal tear, then the worst thing that will happen is a diagnostic arthroscopy which would have occurred if the patient had never had the MRI. If breast MRI detects an enhancing mass that cannot be confirmed by biopsy or any other imaging examination, there are two potential disastrous consequences: 1) Overzealous treatment could result in needless and permanent deformity. 2) The results of the MRI positive lesion are ignored and the patient may lose the opportunity for cure in a lesion confined to the breast. Until MRI directed biopsy capability is available, the clinical value of this examination is questionable. MRI may be used for the evaluation of possible free silicone from implant leaks. The ultimate role of MRI in this evaluation compared with sonography is uncertain.(ABSTRACT TRUNCATED AT 250 WORDS)