Breast MRI supports early detection of breast cancer and assessment of disease extent, particularly in high-risk screening and staging of newly diagnosed disease. It is also used to assess response to neoadjuvant therapy, clarify inconclusive findings, evaluate carcinoma with an unknown primary tumour and assess implant integrity. A 2026 RadioGraphics publication focuses on artifacts that can degrade breast MRI quality, reduce diagnostic confidence, obscure true findings or mimic abnormality. These image problems may arise from technical factors, patient-related issues or the interaction between both. Reliable breast MRI depends on consistent protocols, appropriate equipment use, careful patient positioning, correct contrast administration and systematic recognition of common image distortions.
Technical Factors Behind Artifacts
Breast MRI is typically performed with a dedicated breast coil and a high-field-strength magnet. Standard protocols include fluid-sensitive T2-weighted imaging, precontrast T1-weighted imaging and multiphasic postcontrast T1-weighted imaging for dynamic contrast-enhanced assessment. Fat suppression is commonly used to improve lesion visibility, while subtraction imaging helps separate enhancement from background signal. Abbreviated and ultrafast protocols can reduce examination time while retaining sequences considered important for cancer detection.
Technical artifacts may occur when the imaging area, acquisition settings or postprocessing workflow are not optimised. A field of view that is too small may exclude relevant anatomy, including parts of the breast or axilla. A field of view that is too large may reduce spatial detail. Inadequate contrast delivery can also affect interpretation, particularly when vascular, myocardial or background tissue enhancement does not change as expected.
Radiofrequency interference may create linear bands of noise, often linked to shielding problems or electronic interference in the imaging environment. Aliasing, also called wraparound, occurs when anatomy outside the selected imaging area appears within the image. This is especially relevant when the arms, chest wall or axillary regions are close to the imaging volume. Increasing the field of view, using oversampling or applying saturation bands can help reduce this problem.
Image Distortions That Affect Interpretation
Some artifacts can look like pathology or hide clinically relevant findings. Parallel imaging artifacts may occur when coil performance, patient positioning or calibration is suboptimal. They can appear as duplicated anatomy, local signal loss or distortion, particularly in posterior, medial or axillary regions. Appropriate coil selection, careful positioning, calibration and conservative acceleration settings can help maintain image reliability.
Magnetic susceptibility artifacts arise near materials that alter the local magnetic field. Examples include biopsy markers, surgical clips, tissue expanders, implants with magnetic ports and tattoos containing metallic pigments. These artifacts may cause signal loss, distortion or reduced visibility of adjacent tissue. Increasing receiver bandwidth, reducing echo time and using less sensitive sequence types can help reduce distortion near metal. Alternative fat suppression methods may also be useful when conventional techniques are unreliable.
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Misregistration occurs when images acquired at different times do not align properly. It is especially important in dynamic contrast-enhanced imaging, diffusion-weighted imaging and subtraction images. Patient movement, respiratory or cardiac motion and geometric distortion can create artificial borders, duplicated structures or false enhancement. Careful comparison with unenhanced images and use of registration tools, when available, help reduce the risk of misinterpretation.
Chemical shift artifacts result from differences between fat and water signal behaviour. They may appear as bright and dark bands or as a dark rim at tissue interfaces. These appearances can alter perceived lesion margins or simulate abnormal features. Dixon-based techniques, STIR sequences and parameter optimisation can reduce their impact.
Patient-Related Challenges and Prevention
Patient-related artifacts are common because breast MRI requires stable positioning throughout acquisition. The breasts should hang freely in the coil, with symmetric alignment and without skin folds. Direct contact with the coil, breast asymmetry or shallow positioning can lead to uneven signal and failed fat suppression. Excessive compression, torsion or displacement should be avoided because it may affect perfusion and reduce contrast enhancement.
Arm position also influences image quality. Arms raised above the head can improve coil fit and reduce wraparound artifacts by moving the arms away from the imaging volume. However, this position may increase discomfort and fatigue, which can lead to movement during longer examinations. Arms placed beside the body may be more comfortable, especially after surgery or in claustrophobic patients, but may increase aliasing and field inhomogeneity.
Motion remains one of the most frequent causes of image degradation. Movement from restlessness, breathing, cardiac pulsation or vascular flow can produce blurring, ghosting or misalignment. Clear instructions, comfort measures, selected use of mild anxiolytics, rapid acquisition, motion-compensated methods and careful phase-encoding choices can help reduce motion effects.
Large breast size or body habitus can make positioning and coil fit more difficult. Tissue may extend beyond the sensitive coil area or press against the coil edge, reducing signal uniformity and fat suppression. Adjusting the imaging area, changing the phase-encoding direction or adding targeted sequences can improve coverage.
Breast MRI quality depends on managing both technical and patient-related sources of artifact. Common challenges include limited anatomic coverage, contrast delivery problems, radiofrequency interference, wraparound, metal-related distortion, fat suppression failure, misregistration, motion and positioning difficulties. Systematic recognition of these appearances supports more confident interpretation. Consistent quality control, equipment calibration, coil checks, staff training and protocol standardisation help reduce artifacts and support reproducible, high-quality breast MRI examinations.
Source: Breast Imaging
Image Credit: iStock
References:
Quispe Villca F, Pesce KA, Choque Leniz G et al. (2026) Artifacts at Breast MRI: Appearances and Solutions. Breast Imaging; 46(6).
