MRI Breast
MRIVaries
Outpatient
All imaging requests must be justified by an IR(ME)R practitioner (radiologist or radiographer)High-risk screening (CG164)
— ANY of the following
- Annual MRI for BRCA1/BRCA2 30–49 or >30% carrier probabilityNICE CG164
- Annual MRI for TP53 20–49 or >30% carrier probabilityNICE CG164
- Do NOT offer for moderate risk only or bilateral mastectomy
- MRI sensitivity in BRCA carriers 90% vs mammography 37.5%
Pre-operative assessment (NG101)
Do NOT routinely use MRI for preoperative assessment. Offer when: disease extent unclear; breast density limits mammography; lobular cancer size assessment.
- Do NOT routinely use MRI for preoperative assessmentNICE NG101 Rec 1.1.1
- Offer when: disease extent unclear on conventional imaging
- Offer when: breast density limits mammography assessment
- Offer when: lobular cancer size assessment needed
Implant assessment
— ANY of the following
- USS first-line for suspected rupture
- MRI if USS equivocalRCR 5th edition 2025
Occult primary
— ANY of the following
- MRI detects occult primary in 50–86% — perform before surgery
Neoadjuvant response
— ANY of the following
- MRI most accurate for residual tumour (71–90% accuracy)
Post-treatment surveillance
— ANY of the following
- Do NOT offer USS/MRI for routine surveillanceNICE NG101 Rec 1.13.3
Notes
Warning
Do NOT routinely use MRI for preoperative assessment
NICE NG101Information
MRI sensitivity 90% in BRCA carriers vs 37.5% for mammography
Information
MRI detects occult primary in 50–86% of cases
Removed
Routine post-treatment MRI surveillance not recommended
NICE NG101Pregnancy
Breast MRI can be performed in pregnancy without gadolinium. Gadolinium contraindicated.
Guideline Corrections
NG224 → CG164 (2013, remains current)
References to 'NG224' as replacing CG164 are incorrect — CG164 remains current
Change Log
v2.02026-03-08New protocol — MRI breast indications (screening, pre-op, implants, occult primary)