Objective. To describe the rationale, the technical requirements and t
he examination technique of dynamic magnetic resonance. studies of the
breast and to assess the role of this method in the clinical diagnost
ic protocol. Material and methods. We reviewed the relative literature
and compared the results with our personal experience. Results. The e
arliest reports on the possibility of differentiating carcinoma from b
enign tissue with magnetic resonance imaging came from Germany, where
in 1986 Heywang and coworkers used T1-weighted spin-echo sequences bef
ore and after i.v. Gd-DTPA administration with an imaging time of appr
oximately 5 mins and 5 mm slice thickness. With advances in magnetic r
esonance technology, Heywang-Koebrunner adopted a static three-dimensi
onal fast low-angle shot technique permitting <3 mins' imaging time an
d providing high resolution with thin slices. This approach may detect
even the carcinoma which occasionally does not enhance in the typical
rapid, intense way. A review of 400 biopsy-proved lesions showed that
all carcinomas enhanced strongly, all but 5% rapidly and 85% focally.
Over 70% of benign masses exhibited no major contrast uptake, althoug
h some benign tumors and proliferative dysplasias enhanced strongly. A
t present, Heywang-Koebrunner use rapid three-dimensional gradient-ech
o sequences (TR/TE 14/7, FA 25 degrees; at 1.0 T) which have the advan
tages of three-dimensional imaging and permit dynamic studies (< 1 min
/sequence). The same sequence is used at our institution. The dynamic
technique is advocated by Kaiser who in 1989 reported preliminary sens
istivity and specificity values over 95%. The time/signal intensity cu
rves revealed the rapid and strong enhancement of malignancies, the gr
adual and strong enhancement of the only fibroadenoma studied, and the
gradual and mild contrast uptake of benign dysplasia. In 1992, in nea
rly 1000 dynamic examinations, Kaiser and Reiser reported 98.3% sensit
ivity, 97.0% specificity, 82.1% predictive value and 97.2% accuracy. T
he combination of rapid acquisition with techniques that preserve high
spatial resolution may improve specificity by allowing the study of l
esion morphology as well as of enhancement patterns. A whole-breast im
aging technique has been reported which permits acquisition times <15
s by partial sampling of the central k-space region superimposed on hi
gh-resolution three-dimensional images. Conclusions. Dynamic magnetic
resonance imaging of the breast is currently an important step of the
clinical protocol of breast diseases, but there is no established stud
y protocol yet. (C) 1998 Elsevier Science Ireland Ltd. All rights rese
rved.