BREAST IMAGING: Breast MRI

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

History

68-year-old woman undergoing screening MRI 1 year after lumpectomy.

Imaging Findings

Axial (A) and sagittal (B) contrast-enhanced T1-weighted fat-suppressed breast MR images show a lobulated mass with irregular margins and rim enhancement in the lower outer right breast. T1-weighted image obtained without fat suppression (C) show that the center of the mass has high signal intensity like that of the surrounding breast fat. Right craniocaudal mammogram (D) shows dystrophic and rim calcifications surrounding a radiolucent mass in the lateral breast.

Diagnosis

Fat necrosis

Teaching Points

Imaging findings of central tissue that has the same signal characteristics as fat in all sequences support the diagnosis of fat necrosis.

A history of surgery or trauma can be a key factor in making the diagnosis of fat necrosis.

Mammography is a cost-effective method of evaluating for the lucency or dystrophic calcifications associated with fat necrosis suspected on MRI.

Suggested Readings

Li J, Dershaw DD, Lee CH, Joo S, Morris EA. Breast MRI after conservation therapy: usual findings in routine
follow-up examinations. AJR 2010; 195:799–807

Taboada JL, Stephens TW, Krishnamurthy S, Brandt KR, Whitman GJ. The many faces of fat necrosis in the breast.
AJR 2009; 192:815–825

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