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Breast MRI using CAD - improving diagnosis and efficiency

October 26, 2011
From the October 2011 issue of HealthCare Business News magazine
by Pupinder Jaswal, M.D.

This article originally appeared in the October 2011 edition of DOTmed Business news

It is now possible to localize and stage certain cancers more accurately than just a few years ago.

Compared to standard mammography, breast MRI with CAD provides incredible detail and helps radiologists better determine sizes and locations of tumors, especially in patients with dense breast tissue. The study can serve as a roadmap before surgery or other treatments because of its ability to find more (or less) affected tissue than initially suspected or than was indicated with mammography alone. Often, it helps patients visually understand why a certain course of action is taken or surgery must be performed.

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The CAD software analyzes all the MRI images and creates colorized maps based on direct signal changes due to influx and efflux rates of a contrast agent flowing into and out of suspicious lesions. As a result, radiologists receive qualitative information about the breast tissue and the colored areas highlight areas of suspicion. For example, the blue areas are suspicious 9 percent of the time, green areas are suspicious 12 percent of the time red areas are suspicious 57 percent of the time. These colorized images and additional data assist clinicians in effectively finding potential cancers and communicating available treatment options to patients.

When looking at MRI scans, CAD helps separate out the good — which could just be dense breast tissue — from the bad, which are the cancerous lesions. With high-quality images and processing, it allows for more efficiency and brings radiologists out of no-man’s-land when it comes to making a diagnosis.

While the color mapping is helpful to draw the eye to areas or lesions that require further evaluation, it is important that radiologists interpret the exams first before reviewing with CAD technology. It is meant to support the screening process, not replace standard interpretation protocols.

Improving efficiency
CAD for MRI was initially developed to assist radiologists with the processing and reporting related to breast MRI studies. Because an MRI generates over a thousand images per study, CAD helps screeners focus on areas of greatest concern.

Over time, it became clear CAD was a useful tool to improve efficiency during the reading process. In breast MRI exams where there are many spots erupting, the challenge has always been how to differentiate them. CAD helps to quickly differentiate between multiple spots, allowing for drastically reduced read times. The standard breast MRI process usually takes several hours, with time allotted for reviewing each lesion found during the study. With CAD, the completed exam can take as little as 25 minutes.

Breast MRI with CAD is intended to complement standard screening and diagnostic tools such as mammography and surgical or needle biopsies. Including CAD with breast MRI for cancer screening is a continually developing addition to the push toward earlier detection of breast cancer. The American Cancer Society recommends patients with 20 percent or higher lifetime risk for developing cancer start screening at age 30 and have both screening mammography and a breast MRI annually. CAD does and will continue to play an important role in breast cancer detection.

Dr. Jaswal is a board-certified radiologist at Radiology Associates of Hartford, P.C., specializing in breast imaging and breast biopsy services. He received his medical degree from Baroda Medical College, MS University of Baroda, and completed his residency at University of Connecticut School of Medicine.

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