23Na-MRI for breast cancer diagnosis and treatment monitoring: A scoping review

(1) Background: Variations in intracellular and extracellular sodium levels have been hypothesized to serve as biomarkers for tumour characterization and therapeutic response. While previous research has explored the feasibility of 23Na-MRI, a comprehensive review of its clinical utility in breast cancer is lacking. This scoping review aims to synthesize existing literature on the potential role of 23Na-MRI in breast cancer diagnosis and treatment monitoring. (2) Methods: This review included English-language studies reporting on quantitative applications of 23Na-MRI in breast cancer. Systematic searches were conducted across PubMed, Emcare, Embase, Scopus, Google Scholar, Cochrane Library, and Medline. (3) Results: Seven primary studies met the inclusion criteria, highlighting the ability of 23Na-MRI to differentiate between malignant and benign breast lesions based on elevated total sodium concentration (TSC) in tumour tissues. 23Na-MRI also showed potential in early prediction of treatment response, with significant reductions in TSC observed in responders. However, the studies varied widely in their protocols, use of phantoms, field strengths, and contrast agent application, limiting inter-study comparability. (4) Conclusion: 23Na-MRI holds promise as a complementary imaging modality for breast cancer diagnosis and treatment monitoring. However, standardization of imaging protocols and technical optimization are essential before it can be translated into clinical practice.