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High-Spatial-Resolution MRI of Non-Masslike Breast Lesions: Interpretation Model Based on BI-RADS MRI Descriptors

¹ Present address: Division of Diagnostic Imaging, Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan 296-8602.
² Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.

OBJECTIVE. The purpose of this study was to assess an interpretation model based on BI-RADS MRI descriptors and high-spatial-resolution MR images in lesions showing non-masslike enhancement.

MATERIALS AND METHODS. Retrospective review was performed of 30 consecutive lesions showing non-masslike enhancement. MRI was performed on a 1.5-T scanner using the volumetric interpolated breath-hold examination sequence. The distribution patterns were classified into three categories: single quadrant/solitary lesion (linear), single quadrant/grouped lesion (focal, regional, segmental), and multiquadrant lesion (multiple regions, diffuse). The presence of a ductal pattern was assessed in the enhancing lesions after the tumor distribution had been decided. In addition to the BI-RADS MRI descriptors, the presence of clustered ring enhancement was also assessed in heterogeneous enhancing lesions.

RESULTS. The most frequent morphologic finding among the benign lesions was a linear pattern (50%) followed by homogeneous internal enhancement (42%), whereas a segmental pattern (56%) (p = 0.003), heterogeneous internal enhancement (44%), and clustered ring enhancement (44%) (p = 0.01) were the most frequent findings in malignant lesions. The features with the highest positive predictive value for carcinoma were a segmental distribution (100%), a clustered ring enhancement (100%), and a clumped internal architecture (88%). Using this interpretation model, the positive predictive value for carcinoma was 94%.

CONCLUSION. A combination of BI-RADS MRI descriptors and clustered ring enhancement criteria is useful for the differential diagnosis of lesions showing non-masslike enhancement.

Keywords: BI-RADS MRI descriptors • breast • breast cancer • high spatial resolution • MRI

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