Rationale and objectives To evaluate the feasibility and advantages of a combined high temporal/high spatial resolution protocol for DCE-MRI of the breast. Materials and methods Twenty-three patients with enhancing lesions were imaged at 3T. The acquisition protocol consisted of a series of bilateral, fat-suppressed ‘ultrafast’ acquisitions, with 6.9-9.9 s temporal resolution, for the first minute following contrast injection; followed by four high spatial resolution acquisitions with 60–79.5 s temporal resolution. All images were acquired with standard uniform Fourier sampling. A filtering method was developed to reduce noise and detect significant enhancement in the high temporal resolution images. Time-of-arrival (TOA) was defined as the time at which each voxel first satisfied all the filter conditions, relative to the time of initial arterial enhancement. Results Ultrafast images improved visualization of the vasculature feeding and draining lesions. A small percentage of the entire field-of-view (<6%) enhanced significantly in the 30 s following contrast injection. Lesion conspicuity was highest in early ultrafast images, especially in cases with marked parenchymal enhancement. While the sample size was relatively small, the average TOA for malignant lesions was significantly shorter than the TOA for benign lesions. Significant differences were also measured in other parameters descriptive of early contrast media uptake kinetics (p<0.05). Conclusions Ultrafast imaging in the first minute of breast DCE-MRI has the potential to add valuable information regarding early contrast dynamics. Ultrafast imaging could allow radiologists to confidently identify lesions in the presence of marked background parenchymal enhancement.

Ultrafast imaging is useful for discriminating benign from malignant lesions. The differential utility of ultrafast imaging is comparable to that of standard kinetic assessment in a shorter study time.

Ultrasound was useful for predicting pN2 or higher axillary disease in breast cancer patients. Preoperative ultrasound assessment for staging of axillary lymph nodes might help avoid underestimation at sentinel lymph node biopsy.

A personal history of breast cancer is an important risk factor for the development of subsequent breast cancer. Given the results, consideration should be given to MRI screening of patients with a personal history of breast cancer.

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