IUDs may cause background enhancements on breast MRI
Research presented at the Radiological Society of North America Annual Meeting 2021 has revealed that intrauterine contraceptive device (IUDs), are linked to an increase in background enhancement breast MRI.
About 10.4% of women between the ages of 15 and 49 of age who take contraceptives use an IUD or contraceptive implant, according to the Centers of Disease Control and Prevention. Unlike oral or transdermal hormonal contraceptives and hormone replacement therapy, levonorgestrel-releasing IUDs release a small amount of the hormone directly into uterus and are thought to have a much more localized effect, Luisa Huck, MD, the lead author of the study, told Medscape Medical News in an email.
But women with IUDs have reported for years adverse effects associated with other hormonal medication. Huck, a radiology resident at RWTH-Aachen University in Germany said that some women have reported depression and headaches.
Christiane Kuhl, MD, director of the Department of Radiology at RWTH Aachen University and the senior author of the study and had observed that women who use hormonal IUDs frequently have an increase in background parenchymal enhancement (BPE) on contrast-enhanced MRI. BPE “has been identified as an indicator of hormone stimulation of breast,” the study authors write, and previous studies have revealed that women taking hormonal medications have higher BPE on breast MRIs.
Huck and her colleagues searched the hospital database for premenopausal women that had undergone breast MRIs between January 2014 to July 2020 to better understand if IUDs can increase BPE. To be included, women had to have had at least two scans, one without and one with an IUD, with the scan conducted at least 4 weeks after the placement or removal of an IUD. All women participating in the study did not have a history of breast cancer or hormone or antihormone intake.
The study included 48 women who had an average age of 45 years and a median time of 27 months between scans. Forty-six of the women had the Mirena levonorgestrel-releasing IUD and two had the Jaydess IUD. The researchers used the individual reference points of each patient to account for the different hormone levels within the patients. 25 women had their first MRI without an IUD, and their second with one. This was to control for the effects of age. 23 women from the second group were the first to undergo an MRI without an IUD. They had it removed prior the second scan.
Hormonal effects on breast enhancement are extremely complex, and hormonal stimulation isn’t always predictably correlated with changes on MRI imaging.
Background enhancement was higher in scans that had an IUD than without for 23 women ( P.001). For 24 women, there was no change in BPE with or without an IUD and one woman had lower BPE with an IUD than without.
“It is extremely interesting and pertinent to consider the possibility that the presence of an intrauterine device would have potential impact on the enhancement we see in breast on MRI imaging,” Samantha Heller, MD PhD, associate professor of radiology at New York University School of Medicine in New York City, told Medscape Medical News in an email.
However, the study utilized BPE as a measure of hormonal shifts, and “hormonal effects on breast enhancement are complex, and hormonal stimulation is not always correlated with changes in MRI imaging,” she noted. BPE on MRI can fluctuate, and checking the actual hormone levels of patients who have elevated BPE could be useful to determine the hormonal shifts that are occurring, she added. It is also important to understand why half the women in the study showed no changes in BPE she added.
The results of the study are not surprising considering that progesterone levels in bloodstreams are lower due to IUDs, Frances Casey MD, MPH, associate professor at Virginia Commonwealth University in Richmond wrote in an email. They do not suggest that there should be any changes to IUD guidelines, she added.
Heller said that “the study findings raise questions regarding whether IUD status should be documented prior to conducting breast MRI.” “It is normal to record the time of the menstrual cycle, as well as to note any hormone suppression or replacement therapy. This is in part so that the radiologist can determine the reason behind any variation in background enhancement” she said.
Although enhanced enhancement on MRI has been associated to higher chances of recommendations for additional imaging or biopsies she said, “more work would be needed to study the impact — if any – of an IUD on breast MRI recommendations due to enhancement changes.”
Huck, Heller, Casey did not divulge any relevant financial relationships.
Annual Meeting of the Radiological Society of North America (RSNA), 2021. It was held on November 22nd 2021. Abstract
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