| Summary: | Abbreviated breast magnetic resonance imaging (AB-MRI) has emerged as a supplementary screening tool, though protocols have not been standardized. The purpose of this study was to compare the diagnostic performance of modified and classic AB-MRI and determine MRI features affecting their diagnostic performance. Classic AB-MRI included one pre- and two post-contrast T1-weighted imaging (T1WI) scans, while modified AB-MRI included a delayed post-contrast axial T1WI scan and an axial T2-weighted interpolated scan obtained between the second and third post-contrast T1WI scans. Four radiologists (two specialists and two non-specialists) independently categorized the lesions. The MRI features investigated were lesion size, lesion type, and background parenchymal enhancement (BPE). The Wilcoxon rank-sum test, Fisher’s exact test, and bootstrap-based test were used for statistical analysis. The average area under the curve (AUC) for modified AB-MRI was significantly greater than that for classic AB-MRI (0.76 vs. 0.70, <i>p</i> = 0.010) in all reader evaluations, with a similar trend in specialist evaluations (0.83 vs. 0.76, <i>p</i> = 0.004). Modified AB-MRI demonstrated increased AUCs and better diagnostic performance than classic AB-MRI, especially for lesion size > 10 mm (<i>p</i> = 0.018) and mass lesion type (<i>p</i> = 0.014) in specialist evaluations and lesion size > 10 mm (<i>p</i> = 0.003) and mild (<i>p</i> = 0.026) or moderate BPE (<i>p</i> = 0.010) in non-specialist evaluations.
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