BREAST IMAGING: Breast MRI

Case Author: Peter R. Eby, MD, Virginia Mason Medical Center

History

47-year-old woman without symptoms but at high risk undergoing screening breast MRI.

Imaging Findings

Axial (A) and sagittal (B) contrast-enhanced T1-weighted fat-suppressed breast MR images show a segmental area of linear nonmasslike enhancement (NMLE) in the 9 o’clock position, middle depth, in the right breast. Axial image from postprocessing computer-aided evaluation (C) shows that almost none of the NMLE meets the color threshold. Subsequent diagnostic spot magnification craniocaudal (D) and mediolateral (E) mammograms confirm the presence of a focal area of amorphous and indistinct calcifications at the site of the segmental linear NMLE.

Diagnosis

Ductal carcinoma in situ

Teaching Points

The enhancement kinetics of ductal carcinoma in situ (DCIS) tend to be slower than those of invasive ductal carcinoma in the initial phase and persistent in the delayed phase.

The kinetics of DCIS may not meet the color threshold after processing with a computer-aided evaluation system.

Linear and segmental nonmasslike enhancement always should be sought in two orthogonal planes.

Suggested Readings

Kuhl CK. Why do purely intraductal cancers enhance on breast MR images? Radiology 2009; 253:281–283

Rosen EL, Smith-Foley SA, DeMartini WB, Eby PR, Peacock S, Lehman CD. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J 2007; 13:545–550

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