MRI Exam-Specific Parameters: Breast (Revised 5-2-2024)

Revision History

In addition to the exam-specific instructions in the following table, review the following information prior to examination selection and submission. Failure to follow the guidance below may result in failure of the submitted examination.

• Facilities accrediting the breast module under MR Accreditation must submit 1 case with a known, enhancing, biopsy-proven carcinoma clearly visible in the breast parenchyma.

• The laterality and location of new carcinoma must be indicated on the data form.

• The case must be a bilateral exam of native breasts (i.e., no TRAM or autologous tissue reconstructions). 

• The MRI must be performed prior to any surgery on the breast with cancer (e.g., excisional biopsy or lumpectomy). 

• The MRI must be performed prior to any treatment on the breast with cancer (e.g., neoadjuvant chemotherapy). 

• You may submit a case of a patient with a new cancer who has had an old lumpectomy or biopsy at a different location within the breast, as long as it has a known, enhancing, biopsy-proven carcinoma clearly visible in the breast parenchyma. 

• Needle biopsies may have been conducted either before or after the MRI; excisional biopsies must have been conducted after the MRI. The biopsy may be performed under guidance of any imaging modality (it need not be performed under MR-guidance). The biopsy need not be performed at the applicant’s facility; however, you should have a copy of the results so that you know the case was a biopsy-proven carcinoma. 

• Do not submit a pathology report with the cancer case.

• Do not submit exams from mastectomy patients. This is important because:

  • Unilateral cases do not allow ACR reviewers to evaluate your facility’s ability to acquire bilateral exams (i.e., they aren't necessarily representative of the timing or spatial resolution of a bilateral exam).

  • The reviewers will not be able to determine if both sides of the breast coil are working properly without both breasts present.

  • It eliminates symmetry that clinical readers and reviewers depend on.

• You may submit a case from a patient with implants, as long as the exam is bilateral and the implants are in place with the native breast tissue. Cases from patients who have implants for mastectomy reconstruction should not be submitted. Cases from patients reconstructed with TRAM, latissimus or other autologous tissue flaps (with or without implants) should not be submitted.

• Each case must include localizer or scout sequences. You should remove the lines from the scout/localizer images before submitting them to the ACR if possible; however, you may submit them with the lines if you cannot remove them.

• You may submit cases for accreditation review with motion correction so long as all submitted cases are examples of your “best work."

• If possible, only submit the required sequences. If incomplete or incorrect sequences are submitted, the unit fails accreditation. We understand that some systems do not allow for the separation of sequences without conducting special reconstructions. The ACR will accept additional sequences under this circumstance, as submitting all the sequences performed is preferable to providing reconstructions that may alter the signals between the pre- and post-contrast series.

• If possible, each sequence should be presented separately and not as “stacked” or “interleaved” sequences (contact your MRI manufacturer representative for assistance). If your manufacturer informs you that it is impossible for your equipment to present the sequences separately, we will accept them; however, reviews may be delayed due to the difficulty of reviewing these cases.

Requirements are summarized in the table below. Facilities not submitting the required sequences or submitting cases that do not meet the following criteria may result in failure.

* Specifications for the T2-weighted/bright fluid series: 

• May be run as a single series on both breasts or as 2 separate series, 1 on each breast. In the latter case, 2 separate series numbers and data should be entered in the Test Image Data form under “T2-Weighted Bright Fluid Series” so the reviewers will know that you did both breasts with a T2-weighted series. You do not need to bind them into a single series.

• Contrast should generally not appear in a good quality T2-weighted bright fluid series. The addition of a contrast agent during T2W imaging is likely to decrease the visibility of bright vessels and could compromise bright fluid evaluation. 

• An Ax T2 fat-sat sequence is desirable. A Short TI Inversion Recovery (STIR) image with TI set to suppress fat signal may be considered a T2-weighted/bright fluid series if it successfully shows fluid to be bright. A T2*-weighted or non-spoiled (steady state) T1-weighted gradient echo pulse sequence also may be satisfactory as a bright fluid sequence if it shows fluid as being adequately bright (i.e., brighter than all other tissues in the breast). 

**Specifications for the multi-phase T1-weighted series: 

• The intent of early phase and delayed phase post-contrast imaging is to capture information on lesion enhancement in the early and late phases of post-contrast enhancement.

• Must be run bilaterally, with both the left and right breasts in the same series.

• May be in 3 separate series, in 2 series (i.e., 1 for pre-contrast, the rest for post-contrast), or in a single series (i.e., pre-contrast and post-contrast).

• All 3 multi-phase series (with the exception of Aurora systems) should match in terms of spatial and temporal parameters. Some small deviations may exist in the parameters listed in the series DICOM header files (e.g., in TR and TE values) between the pre- and post-contrast series. As long as these differences are small and do not affect the ability to subtract pre- from post-contrast series, such small differences are acceptable. Aurora EDGE software uses a distinctly different acquisition time for the pre- contrast series compared with that of the post-contrast series. This difference is acceptable.

• Pre-contrast T1W series must have sufficient dark fluid contrast. Short TR/short TE are required. 

• Fat suppression may be used for the pre-contrast and the post-contrast sequences. 

• Subtracted images are not required. However, if chemical-shift (i.e., frequency-selective) fat suppression is not used or is not evident in the multi-phase T1 weighted series, then subtraction of pre-contrast from post-contrast series may be used to eliminate the bright signal from fat. If this is done, then both the unsubtracted (source) series and the subtracted series  (i.e., pre-contrast subtracted from post-contrast, slice by slice) must be included for both the early and delayed phases. 

• At least 2 phases of post-contrast images must be submitted: the earliest and the latest phase post-contrast series

• Post-processed data from CAD systems is not required unless you do not perform fat-saturation on the multiphase T1-weighted series and need to submit subtracted images corresponding to the early-phase and late-phase post contrast series along with the originally acquired pre-contrast, early-phase post-contrast and late-phase post contrast images.

• The first post-contrast sequence must be completed in ≤ 4.0 minutes of completion of contrast injection.