Dynamic High-Spatial-Resolution MR Imaging of Suspicious Breast Lesions
Diagnostic Criteria and Interobserver Variability
Karen Kinkel1,2,
Thomas H. Helbich1,3,
Laura J. Esserman4,
John Barclay5,
Ellen H. Schwerin1,
Edward A. Sickles1 and
Nola M. Hylton1
1
Division of Radiology, Magnetic Resonance Science Center, University of
California, Box 1290, 1 Irving St., Rm. AC-109, San Francisco, CA
94143-1290.
2
Present address: Department of Radiology, Hopitaux Universitaires de Geneve,
Hopital Cantonal, 24, rue Micheli-du-Crest, CH-1211 Geneve 14,
Switzerland.
3
Present address: Department of Radiology, University of Vienna AKH, Waehringer
Guertel, Vienna 1090, Austria.
4
Department of Surgery, University of California, San Francisco, CA
94143.
5
Department of Epidemiology and Biostatistics, University of California, San
Francisco, CA 94143.
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Fig. 1A. —67-year-old woman with suspicious density on mammography and normal
findings on sonography. Unenhanced (A) and first (B) and second
(C) contrast-enhanced high-spatial-resolution three-dimensional fast
gradient-recalled echo images reveal small focal mass corresponding to
invasive cancer at histopathology. First contrast-enhanced image (B) at
2 min 30 sec shows irregular borders at posterior portion of mass
(arrow, B). On second enhanced image (C), slight
washout enhancement pattern (arrow, C) can be identified at 7
min 30 sec in central portion of mass.
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Fig. 1B. —67-year-old woman with suspicious density on mammography and normal
findings on sonography. Unenhanced (A) and first (B) and second
(C) contrast-enhanced high-spatial-resolution three-dimensional fast
gradient-recalled echo images reveal small focal mass corresponding to
invasive cancer at histopathology. First contrast-enhanced image (B) at
2 min 30 sec shows irregular borders at posterior portion of mass
(arrow, B). On second enhanced image (C), slight
washout enhancement pattern (arrow, C) can be identified at 7
min 30 sec in central portion of mass.
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Fig. 1C. —67-year-old woman with suspicious density on mammography and normal
findings on sonography. Unenhanced (A) and first (B) and second
(C) contrast-enhanced high-spatial-resolution three-dimensional fast
gradient-recalled echo images reveal small focal mass corresponding to
invasive cancer at histopathology. First contrast-enhanced image (B) at
2 min 30 sec shows irregular borders at posterior portion of mass
(arrow, B). On second enhanced image (C), slight
washout enhancement pattern (arrow, C) can be identified at 7
min 30 sec in central portion of mass.
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Fig. 2A. —61-year-old woman with 1-cm spiculated mass on mammography and
indeterminate results at fine-needle aspiration. Focal mass with spiculated
margins is less visible on unenhanced (A) than on first (B) and
second (C) contrast-enhanced high-spatial-resolution three-dimensional
fast gradient-recalled echo images. Strong degree of enhancement and
spiculated margins are highly suspicious of malignancy (B). At 7 min 30
sec (C), heterogeneous washout pattern is identified in mass
(arrow, C). Histopathology results showed 1.3-cm invasive
cancer with surrounding ductal carcinoma in situ.
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Fig. 2B. —61-year-old woman with 1-cm spiculated mass on mammography and
indeterminate results at fine-needle aspiration. Focal mass with spiculated
margins is less visible on unenhanced (A) than on first (B) and
second (C) contrast-enhanced high-spatial-resolution three-dimensional
fast gradient-recalled echo images. Strong degree of enhancement and
spiculated margins are highly suspicious of malignancy (B). At 7 min 30
sec (C), heterogeneous washout pattern is identified in mass
(arrow, C). Histopathology results showed 1.3-cm invasive
cancer with surrounding ductal carcinoma in situ.
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Fig. 2C. —61-year-old woman with 1-cm spiculated mass on mammography and
indeterminate results at fine-needle aspiration. Focal mass with spiculated
margins is less visible on unenhanced (A) than on first (B) and
second (C) contrast-enhanced high-spatial-resolution three-dimensional
fast gradient-recalled echo images. Strong degree of enhancement and
spiculated margins are highly suspicious of malignancy (B). At 7 min 30
sec (C), heterogeneous washout pattern is identified in mass
(arrow, C). Histopathology results showed 1.3-cm invasive
cancer with surrounding ductal carcinoma in situ.
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Fig. 3A. —65-year-old woman with spiculated mass on mammography and general
contraindication for surgery. Unenhanced (A) and first (B) and
second (C) contrast-enhanced high-spatial-resolution three-dimensional
fast gradient-recalled echo images reveal small spiculated mass. Although
second contrast-enhanced image (C) at 7 min 30 sec shows slightly
progressive enhancement pattern (arrow, C), final
histopathology revealed invasive ductal cancer.
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Fig. 3B. —65-year-old woman with spiculated mass on mammography and general
contraindication for surgery. Unenhanced (A) and first (B) and
second (C) contrast-enhanced high-spatial-resolution three-dimensional
fast gradient-recalled echo images reveal small spiculated mass. Although
second contrast-enhanced image (C) at 7 min 30 sec shows slightly
progressive enhancement pattern (arrow, C), final
histopathology revealed invasive ductal cancer.
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Fig. 3C. —65-year-old woman with spiculated mass on mammography and general
contraindication for surgery. Unenhanced (A) and first (B) and
second (C) contrast-enhanced high-spatial-resolution three-dimensional
fast gradient-recalled echo images reveal small spiculated mass. Although
second contrast-enhanced image (C) at 7 min 30 sec shows slightly
progressive enhancement pattern (arrow, C), final
histopathology revealed invasive ductal cancer.
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Fig. 4A. —44-year-old woman with partially obscured mammographic mass and
suspicious shadowing on sonography. Lobulated mass is seen on unenhanced
(A) and first (B) and second (C) contrast-enhanced
high-spatial-resolution three-dimensional fast gradient-recalled echo images.
First contrast-enhanced image (B) at 2 min 30 sec reveals irregular
anterior margins (arrow, B) and nonenhancing septation. Second
contrast-enhanced image (C) at 7 min 30 shows strong progressive
enhancement pattern (arrow, C). Histopathology confirmed
fibroadenoma.
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Fig. 4B. —44-year-old woman with partially obscured mammographic mass and
suspicious shadowing on sonography. Lobulated mass is seen on unenhanced
(A) and first (B) and second (C) contrast-enhanced
high-spatial-resolution three-dimensional fast gradient-recalled echo images.
First contrast-enhanced image (B) at 2 min 30 sec reveals irregular
anterior margins (arrow, B) and nonenhancing septation. Second
contrast-enhanced image (C) at 7 min 30 shows strong progressive
enhancement pattern (arrow, C). Histopathology confirmed
fibroadenoma.
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Fig. 4C. —44-year-old woman with partially obscured mammographic mass and
suspicious shadowing on sonography. Lobulated mass is seen on unenhanced
(A) and first (B) and second (C) contrast-enhanced
high-spatial-resolution three-dimensional fast gradient-recalled echo images.
First contrast-enhanced image (B) at 2 min 30 sec reveals irregular
anterior margins (arrow, B) and nonenhancing septation. Second
contrast-enhanced image (C) at 7 min 30 shows strong progressive
enhancement pattern (arrow, C). Histopathology confirmed
fibroadenoma.
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Fig. 5A. —45-year-old woman with palpable 7-mm noncalcified mass on
mammography. Unenhanced (A) and first (B) and second (C)
contrast-enhanced high-spatial-resolution three-dimensional fast
gradient-recalled echo images show oval mass of changing size. First
contrast-enhanced image (B) at 2 min 30 sec shows strongly enhancing
focal mass with smooth borders (arrow, B). Slight decrease in
size and signal intensity on second contrast-enhanced image (C) at 7
min 30 sec indicate global washout enhancement pattern (arrow,
C). Histopathology revealed benign granular cell tumor.
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Fig. 5B. —45-year-old woman with palpable 7-mm noncalcified mass on
mammography. Unenhanced (A) and first (B) and second (C)
contrast-enhanced high-spatial-resolution three-dimensional fast
gradient-recalled echo images show oval mass of changing size. First
contrast-enhanced image (B) at 2 min 30 sec shows strongly enhancing
focal mass with smooth borders (arrow, B). Slight decrease in
size and signal intensity on second contrast-enhanced image (C) at 7
min 30 sec indicate global washout enhancement pattern (arrows,
C). Histopathology revealed benign granular cell tumor.
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Fig. 5C. —45-year-old woman with palpable 7-mm noncalcified mass on
mammography. Unenhanced (A) and first (B) and second (C)
contrast-enhanced high-spatial-resolution three-dimensional fast
gradient-recalled echo images show oval mass of changing size. First
contrast-enhanced image (B) at 2 min 30 sec shows strongly enhancing
focal mass with smooth borders (arrow, B). Slight decrease in
size and signal intensity on second contrast-enhanced image (C) at 7
min 30 sec indicate global washout enhancement pattern (arrows,
C). Histopathology revealed benign granular cell tumor.
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Fig. 6. —Tree diagram shows diagnostic algorithm for breast lesion
characterization using washout enhancement pattern and margin characteristics.
Lesion showing washout is malignant unless it has smooth margins. Lesion
without washout is benign unless it has spiculated margins. Number of
true-positive (TP), true-negative (TN), false-positive (FP), and
false-negative (FN) results are indicated on right side of figure for each
branch of tree.
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