A closer look at Breast MRI, by Heidi K. Henry, M.D. & Charles S. Henry, M.D.

 Breast MRI is a new procedure and evolving technology that can help doctors make a diagnosis. The technology uses Magnetic Resonance Imaging (MRI) to look specifically at the breast.
Breast MRI is a highly sensitive noninvasive test that examines the inside of the breast through hundreds of images. There is no compression or flattening of the breast during this exam and no radiation exposure.
Most patients getting a breast MRI fall into three categories: patients with newly diagnosed breast cancer, those who have a diagnostic problem that cannot be answered with other testing and patients who are suspected of having a breast implant rupture.
In patients with newly diagnosed breast cancer, breast MRI can be helpful in determining the exact tumor size and extent, which allows for much more accurate surgical planning. Sometimes there is an unsuspected second cancer or the tumor proves to be larger than expected (in as many as ten percent of the cases), which can drastically change the surgical approach and outcome.
Some patients have a diagnostic problem which cannot be answered with mammography and breast ultrasound. An example of a diagnostic problem is a breast lump that is suspicious on physical exam, but not detected by conventional imaging with mammography or ultrasound.
Another common diagnostic problem is an ultrasound or mammographic finding for which the radiologist recommends further evaluation.
For patients who are suspected of having a breast implant rupture, MRI is the most accurate test to determine the integrity of a breast implant.
During the procedure, the patient lies face down on a special breast MRI table that allows her breasts to hang through an opening and allows the MRI to provide very detailed images of each breast. A simple IV line is established beforehand to allow injection of a type of contrast which will help the radiologist determine if there is an any reason to suspect the presence of cancer. The patient must be able to lie still, and the exam takes approximately thirty minutes.
The IV is needed to give a special type of MRI contrast called gadolinium. Breast cancers typically have a rich blood supply, so tumors “light up” on MRI. It is this contrast that makes MRI more sensitive in cancer detection than mammography. Allergies to this type of dye (which is different than “x-ray dye”) are extremely rare.
If the exam is normal, then the chances of the patient having breast cancer are extremely low.
Both MRI and mammography are great exams, each with their own strengths. Most commonly, breast MRI is performed to answer a specific question raised from the patient’s mammogram, as it is a more sensitive test in detecting breast cancer than mammography.
Some cancers can be seen with MRI that cannot be seen with mammography. This is especially true in patients who have dense breast tissue.
Regardless of breast density, if a breast cancer is present, breast MRI can detect it more than ninety-five percent of the time, while mammography can detect cancer approximately eighty to ninety percent of the time. If the patient has dense breast tissue, the rate of detection of cancer can go down to as low as fifty percent by mammogram alone.
For this reason, breast MRI can be important in the sub-group of patients who have dense breast tissue on their mammograms and a change in their mammogram, a palpable lump or a biopsy-proven cancer.
All breast MRIs should be read in conjunction with the patient’s mammogram. Mammography and MRI have different strengths. For example, mammography is better at detecting very tiny calcifications, which can be an early sign of breast cancer.
One drawback to the MRI is cost; the procedure is expensive. While most insurers will cover a large proportion of the cost for appropriate diagnostic uses, they will not cover the cost for screening when there are no symptoms.
In addition, since it is such a sensitive study, there will be higher “false positive” findings than with mammography, and these false positives may require follow-up MRI or a needle biopsy.
This is why it’s essential for highly qualified breast imaging specialists to evaluate a patient’s prior mammograms and ultrasounds to assure that breast MRI is medically necessary for each patient.
—Heidi K. Henry, M.D. &
Charles S. Henry, M.D.
Northcoast Radiology Associates, P.C. Marquette General Hospital

Celebrate National Foot Month in August
What has twenty-six bones, thirty-three joints, 100 muscles and probably is the most abused part of the human body? If you guessed a foot you are right.
Stop and think about the physical stress we place on our feet each day. Now think of the poor footwear choices we inflict on our feet and the added burden of the excess weight many people carry.
The feet of people with diabetes can suffer even more with complications arising from nerve damage and reduced blood flow to the feet.
August is National Foot Health Month. For people with diabetes, following these basic foot-care suggestions can result in a decreased chance of foot infections and other problems.
• Check your feet daily for cuts, bruises, swelling and areas of redness or blisters. Call your doctor if you notice a change.
• Wash your feet daily in warm, not hot, water. Apply a thin layer of moisturizer to your feet, but not between the toes.
• Trim nails straight across. If your nails are too thick—a possible sign of fungus—consult a podiatrist to trim them.
• Don’t soak your feet. Avoid products that dry out your skin such as iodine and peroxide.
• Don’t go barefoot. Slippers with hard soles offer protection around the house.
• Don’t be a slave to fashion. Wear comfortable, well-fitting shoes. Inspect shoes and socks before putting them on.
• Don’t cross your legs as this will cut off circulation. When sitting for extended periods of time, keep your feet up to prevent swelling.
• See your doctor for treatment of corns, calluses and warts. Don’t do “self-surgery.” Ask your doctor to check your feet at every regular appointment.
If you would like more information on foot care, call the U.P. Diabetes Outreach Network at 228-9203 or(800)369-9522 from anywhere in the U.P.
—U.P. Diabetes Outreach Network

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