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Breast Lesions Detected on MR Imaging: Features and Positive Predictive Value

¹ All authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

View larger version (111K): [in a new window]   Fig. 1. —39-year-old woman who had recently undergone excision of nonpalpable, mammographically detected right lower inner-quadrant spiculated mass yielding infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) with tumor at margin. Postoperative mammogram (not shown) revealed dense breasttissue with no suspicious findings. Contrast-enhanced fat-saturated T1-weighted sagittal MR image of right breast obtained approximately 1 month after surgery shows 1.3-cm irregular, spiculated mass with heterogeneous enhancement in right lower outer quadrant (arrow), remote from lumpectomy site, highly suggestive of malignancy. At MR imaging—guided needle localization and surgical excision, this lesion was found to represent 1.7 cm of infiltrating ductal carcinoma and DCIS. Patient under-went mastectomy.

View larger version (80K): [in a new window]   Fig. 2. —53-year-old woman who had undergone prior left-breast lumpectomy and radiation for breast cancer. Mammogram (not shown) revealed moderately dense breast tissue without suspicious findings. Contrast-enhanced fat-saturated T1-weighted sagittal MR image of right breast shows 0.5-cm irregular, spiculated, rim-enhancing mass in right upper inner quadrant (curved arrow) and clumped linear and ductal enhancement (straight arrow) extending anteriorly from that site. MR imaging—guided needle localization and surgical excision yielded infiltrating ductal carcinoma, 0.5 cm, and ductal carcinoma in situ.

View larger version (109K): [in a new window]   Fig. 3. —66-year-old woman with history of right-breast bloody nipple discharge and unsuccessful ductogram. Mammogram (not shown) showed moderately dense breast tissue without suspicious findings. Contrast-enhanced fat-saturated T1-weighted sagittal MR image of right breast shows clumped, segmental enhancement spanning approximately 6 cm in right 6-o'clock axis (arrows). MR imaging—guided localization and surgical excision yielded ductal carcinoma in situ arising in background of atypical ductal hyperplasia and intraductal papillomas. Patient underwent mastectomy.

View larger version (93K): [in a new window]   Fig. 4. —51-year-old woman who had undergone right 12-o'clock axis lumpectomy and radiation therapy for infiltrating lobular carcinoma more than 5 years previously. Mammogram (not shown) revealed mildly dense breast tissue with no suspicious findings. Contrast-enhanced fat-saturated T1-weighted sagittal MR image of right breast shows low signal at site of clips from prior lumpectomy in right 12-o'clock axis. In 6-o'clock axis, spanning 2.3 cm is clumped, linear enhancement (arrows), highly suggestive of malignancy. MR imaging—guided needle localization and surgical excision yielded ductal carcinoma in situ. Subsequent mastectomy was performed.

View larger version (81K): [in a new window]   Fig. 5. —37-year-old woman who had recent excision of palpable, mammographically occult mass in left breast upper outer quadrant yielding infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS) with tumor extending close to margin. Contrast-enhanced fat-saturated T1-weighted sagittal MR image of left breast shows postoperative seroma (open arrow) with extensive adjacent clumped, regional enhancement (solid arrows), highly suggestive of residual disease. MR imaging—guided needle localization yielded DCIS, for which patient had mastectomy.

View larger version (87K): [in a new window]   Fig. 6A. —58-year-old woman who had right mastectomy for breast cancer 2 years previously. Mammogram (not shown) depicted moderately dense breast tissue without suspicious findings. Contrast-enhanced fat-saturated T1-weighted sagittal MR image of left breast shows 1-cm lobulated, smooth, homogeneously enhancing mass (arrow) in left lower outer quadrant.

View larger version (96K): [in a new window]   Fig. 6B. —58-year-old woman who had right mastectomy for breast cancer 2 years previously. Mammogram (not shown) depicted moderately dense breast tissue without suspicious findings. Same contrast-enhanced fat-saturated T1-weighted sagittal MR image of left breast adjusted to different window and level settings illustrates impact of these settings on interpretation. In image, enhancement pattern of mass (arrow) appears more heterogeneous. MR imaging—guided needle localization and surgical excision yielded infiltrating lobular carcinoma, for which mastectomy was performed.

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