MRI mammography is more accurate than mammography in detecting breast diseases. A study compared MRI and mammography on 15 patients and found MRI detected 12 cases of ductal carcinoma in situ (DCIS) in the right breast that mammography missed, and 10 cases of DCIS in the left breast that mammography also missed. MRI mammography had a sensitivity of 100% while mammography's sensitivity was only 18% in detecting breast cancers. MRI is better able to detect lesions obscured by dense breast tissue and can find additional, missed tumors in the other breast of cancer patients. However, further large-scale studies are still needed to continue validating MRI mammography.

1. Comparison between mammogramComparison between mammogram
and MRI mammogram in detectingand MRI mammogram in detecting
breast diseasebreast disease
Nordina binti Nordin
Supervior: Miss Angela Lema Anak Thomas Sudin
Degree in Medical Imaging (HONS)
UniversitI Teknologi Mara

2. Outline:Outline:
o Introduction
o Literature review
o Research hypothesis
o Methodology
o Results
o Discussion
o Recommendation

4. Researchers had noted that there are some problems with
mammography:
some palpable or non palpable lesion is not visible by
mammography (Kopans, 1992).
radiodense breast tissue can obscure cancer
mammography also is not good enough to differentiate whether the
lesion is benign or malignant (Kopans, 1992).
Objective of the study :
to evaluate the accuracy of MRI compare with mammography in
detecting breast disease or pathologies.

6. Sensitivity of MRI mammogram:Sensitivity of MRI mammogram:
Authors: Mammogram
MRI
Mammogram Note:
Malur et al. (2000) 83.70% 94.60%
Stoutjesdijk et al. (2001) 46.20% 100% From 13 detected breast cancer
Pediconi et al. (2006) 77% 100%
Menell (2006) 3% 64% Of 33 breasts, (DCIS)
Hope (2007) 52% 98% Of 89 women, (DCIS)

7. Advantages of MRI mammogram:Advantages of MRI mammogram:
Authors: Advantages
Kopans
(1992)
 Better delineate the extent of a breast cancer
 Improve the detection of early breast cancers in the radiographically
dense breast
Blumenthal
(1997)
 Able to pinpoint suspicious lesions camouflaged behind dense breast
tissue
 Mammograms have been unable to penetrate sufficiently to accurately
detect
Harmon
(2004)
 2 times more effective than mammography in detecting multiple tumors
 Better than mammography for detecting the presence and extent of
disease
Grady
(2007)
 Can find tumors in the other breast that mammograms miss in
women who have newly diagnosed cancer in one breast

8. MRI is more superior to mammography in
detecting breast disease or pathologies.

10. METHODOLOGYMETHODOLOGY
Retrospective study:
Hospital Sungai Buloh,
Selangor (film reviewed from
year 2007 to Aug 2008).
Samples were chosen
randomly (40 – 55 years
old).
Films prospectively reviewed
by a radiologist.
Radiologist:
aware of the study’s aim
and design.
blinded to the initial
imaging reports or the
final diagnoses.

11. METHODOLOGYMETHODOLOGY
Sample’s details printed on
the mammography and MRI
films de-identified.
Each film was labeled by
number.
Radiologist was given a form
specially formatted for this
study purposes.
The sensitivity and specificity
of both modalities were
compared according to:
previous report by
previous radiologists and
current findings by the
radiologist participated in
this study.
with the support of biopsy
result.

12. METHODOLOGYMETHODOLOGY
Radiologists’ findings were recorded on according to the
following rating scale (BIRADS category):
0 = incomplete assessments
1 = negative (no significant abnormally)
2 = benign
3 = probably benign
4 = suspicious abnormality
5 = highly suspicious of malignancy
Categories 0 - 2 were considered negative for cancer
Categories 3 - 5 were considered positive for cancer

13. METHODOLOGYMETHODOLOGY
15 samples underwent mammogram and MRI mammogram
examination
Each sets of films being interpreted on separated days
according to availability of radiologist in charge in this study
All data were then analyzed by using excel software.

15. RESULTSRESULTS
Figure 1:
 87% considered (-ve) for cancer (BIRADS 0 - 2)
 13% considered (+ve) for cancer (BIRADS 3 - 5)
Figure 2:
 20% considered (-ve) for cancer (BIRADS 0 - 2)
 80% considered (+ve) for cancer (BIRADS 3 - 5)
0
1
2
3
4
5
6
7
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MAMMOGRAM OF RIGHT BREAST
0
1
2
3
4
5
6
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MRI MAMMOGRAM OF RIGHT BREAST

16. RESULTSRESULTS
0
1
2
3
4
5
6
7
8
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MAMMOGRAM OF LEFT BREAST
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MRI MAMMOGRAM OF LEFT BREAST
Figure 3:
 100% considered (-ve) for cancer (BIRADS 0 - 2)
 0% considered (+ve) for cancer (BIRADS 3 - 5)
Figure 4:
 29% considered (-ve) for cancer (BIRADS 0 - 2)
 71% considered (+ve) for cancer (BIRADS 3 - 5)

17. RESULTSRESULTS
Biopsy was performed on 12 right breasts and 10 left breasts
that showed breast abnormalities during MRI examination.
All were confirmed positive ductal carcinoma in situ (DCIS)
accept 1 right breast, diagnosed as benign.

19. THE ACCURACY OF MRITHE ACCURACY OF MRI
COMPARE WITH MAMMOGRAMCOMPARE WITH MAMMOGRAM
Result from mammogram & MRI
mammogram grafts of right breast:
 Decrease 20 % (-ve) for cancer
 Increase 80 % (+ve) for cancer
 Variance of negative result - 67 %
 Variance of positive result - 67 %
Mammography only detected 2
cases that consider positive for
cancer, compared with 12 cases
detected by MRI.
0
1
2
3
4
5
6
7
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MAMMOGRAM OF RIGHT BREAST
0
1
2
3
4
5
6
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MRI MAMMOGRAM OF RIGHT BREAST

20. THE ACCURACY OF MRITHE ACCURACY OF MRI
COMPARE WITH MAMMOGRAMCOMPARE WITH MAMMOGRAM
Result from mammogram & MRI
mammogram grafts of left breast:
 Decrease 29% (-ve) for cancer
 Increase to 71% (+ve) for cancer
 Variance of negative result - 29 %
 Variance of positive result - 71 %
• Mammography not detected at all
cases that positive for cancer,
compared with 10 cases detected
by MRI.
there are only 14 films from the left breast as
one patient had done mastectomy of the left
breast
0
1
2
3
4
5
6
7
8
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MAMMOGRAM OF LEFT BREAST
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
No of films
BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5
BIRADS category
MRI MAMMOGRAM OF LEFT BREAST

21. EXPLANATION OF BIRADSEXPLANATION OF BIRADS
CATEGORYCATEGORY
BIRADS (breast imaging reporting and data system) classification:
Recommended and published by an American College of Radiology.
BIRADS ASSESSMENT EXPLAINATION
0
Assessment
incomplete Utilized when further imaging evaluation or retrieval of prior films is required
1 Negative There is nothing to comment on
2 Benign finding
Normal assessment, but the interpreter chooses to describe a benign finding in the
mammography report
3
Probably benign
finding Have less than 2 percent risk of malignancy
4
Suspicious
abnormality
Do not have the classic appearance of malignancy but have a wide range of
probability of malignancy (2-95 %)
5
Highly suspicious of
malignancy Findings that are classic breast cancers, with more than 95 % likelihood of malignancy
(Zonderland, 2006)(Zonderland, 2006)

22. EXPLANATION OF BIRADSEXPLANATION OF BIRADS
CATEGORYCATEGORY
CE-MRI is the fact that tumors enhance and enhance more than
normal tissues.
Tumors need many blood vessels to grow;
the concentration of the contrast agent at their location will be
higher than in surrounding tissues
appear as brighter areas in the images.
For MRI mammogram, BIRADS categories are categorized
according to the enhancement curve for different types of
tissues.
(Mehnert et al., 2006)

23. Type of
curve: BIRADS Explanation
Type I a. BIRADS 1 (negative)
A kinetic behavior with a persistent uptake is considered a sign of
benignity
b. BIRADS 2 (benign)
Type II BIRADS 3 (probably benign)
A kinetic behavior with a clear plateau phase can be found both in
benign and in malignant features
Type III
BIRADS 4 (suspicious abnormality)
or BIRADS 5 (highly suspicious of
malignancy)
Kinetic behavior with a strong uptake followed by a rapid washout
is considered a sign of malignancy
Enhancement curve for different types of tissues
Mehnert et al. (2006)

24. SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITY
Sensitivity of the right breast:
Out of 15 films, 12 films of MRI mammogram that show BIRADS 3
and above
11 was proven by biopsy confirmed have ductal carcinoma in situ
(DCIS).
Only 1 film actually only benign finding.
Specificity of the right breast:
3 films of MRI mammogram show BIRADS 1 and 2
all was reported as the same as previous radiologist’s report which
confirmed negative for cancer.

25. SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITY
Sensitivity of the left breast:
Out of 14 films, 10 films of MRI mammogram that show BIRADS 3
and above
10 was proven by biopsy confirmed have ductal carcinoma in situ
(DCIS).
Specificity of the left breast:
4 films of MRI mammogram show BIRADS 1 and 2
all was reported as the same as previous radiologist’s report which
confirmed negative for cancer.

26. SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITY
The sensitivity for malignant lesion detection for both right and
left breast was:
100 % for MRI mammogram
18 % for mammography.
Out of 21 samples with DCIS;
Mammography identified 2 cases (10%)
MRI mammography identified 21 cases (100%).
Overall mammograms missed up to 90 % of the breast cancers
that are present at the time of screening.

28. CONCLUSIONCONCLUSION
MRI can detect pathologies missed by mammography
MRI more superior to mammography in detecting breast
disease or pathologies

29. RECOMMENDATIONRECOMMENDATION
 Perform further study on MRI mammogram with more
samples.
 Perform prospective study on MRI mammogram
within 12 months period.
 Future study – comparing ultrasound and MRI of the
breast.

30. ACKNOWLEDGEMENTACKNOWLEDGEMENT
Dr Yun (Head of Department of MI Department of H. Sg. Buloh)
Dr Rofiah (Radiologist of H. Sg. Buloh)
Miss Angela Lema (Project supervisor)
Personnel of Hospital Sungai Buloh
Lecturers, family, & friends.

31. REFERENCEREFERENCE
Blumenthal, S.J., 1997. Testimony on battle against breast cancer, [Online]. Available:
http://www.hhs.gov/asl/testify/t97020a.html [accessed 23 March 2008].
Grady, D., 2007. Call to increase MRI use for breast exam, [Online]. Available:
http://www.nytimes.com/2007/03/28/health/28mri.html [accessed 23 March 2008].
Harmon, R., 2004. MRI significantly better than mammography for detecting number and size of tumors in
breast cancer, [Online]. Available: http://www.innovations
report.com/html/reports/medicine_health/report/ [accessed 23 March 2008].
Hope, J., 2007. MRI scans beat mammograms in detecting breast cancer, [Online]. Available:
http://www.dailymail.co.uk/ [accessed 23 March 2008].
Kopans, D.B., 1992. Detecting breast cancer not visible by mammography, [Online]. Available:
www.cancernetwork.com/ [accessed 23 March 2008].
Malur, S., Wurdinger, S., Moritz, A., Michels, W., & Schneider, A., 2001. Contrast Comparison of written
reports of mammography and MRI for preoperative evaluation of breast lesions, [Online]. Available:
http://www.pubmedcentral.nih.gov/articlerender.fcgi [accessed 23 March 2008].
Mehnert, A., Bengtsson, E., McMahon, K., Kennedy, D., Wilson, S., & Crozier, S., 2006. Improved breast
cancer detection enabled by rapid visualization of suspicious lesions in DCE-MRI of the breast,
[Online]. Available: http://www. E:Breast Cancer Detection using DCE-MRI.mht [accessed 23 March
2008].
Menell, J.H., 2006. MRI can detect breast disease missed by mammography, [Online].
Available:http://www.medicalnewstoday.com/ [accessed 23 March 2008].

32. Pediconi, F., Catalano, C., Padula, S., Roselli, A., Moriconi, E., Dominelli, V., Pronio, A.M., Kirchin,
M.A., & Passariello, R., 2006. Contrast-enhancement magnetic resonance mammography,
[Online]. Available: http://www.springerlink.com/content/ [accessed 23 March 2008].
Stoutjesdijk, M.J., Boetes, C., Jager, G.J., Beex, L., Bult, P., Hendriks, J.H.C.L., Laheij, R.J.F.,
Massuger, L., Wobbes, T., & Barentsz, J.O., 2001. MRI and mammography in women with a
hereditary risk of breast cancer, [Online]. Available: http://jnci.oxfordjournals.org/cgi/content/
[accessed 23 March 2008].
Zonderland, H., 2006. Introduction to the Breast Imaging Reporting and Data System, [Online].
Available: http://www.radiologyassistant.nl/en/ [accesses 23 March 2008].