Breast MR imaging has specific indications . It is complimentary to mammography for high risk patients like those positive for BRCA-1 and BRCA-2 gene mutations and their untested relatives as well as patients suffering from Li-Fraumeni, Cowden, Bannayan-Riley-Ruvalcaba syndromes and their first degree relatives. Patients who received chest radiation therapy treatments between the ages of 10 and 30 years and those with a general 20%increased risk for breast cancer are also eligible. That risk assessment is difficult and includes different factors ( age, personal and familial history, breast density, ... ) and methods ( (Gail, Tyrer-Cuzick, BRCAPRO, Claus ).
Breast MRI can also be helpful for the evaluation of the extension of neoplasia in patients diagnosed with invasive lobular carcinoma and sometimes invasive ductal carcinoma. It can also aid in the detection of an occult neoplasia diagnosed after lymph node biopsy.
Finally, MR can be problem solving when mammography and ultrasound are indeterminate. But it can never replace a biopsy.