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Nonenhancing Breast Malignancies on MRI: Sonographic and Pathologic Correlation

¹ St. Michael's Hospital, University of Toronto, Medical Imaging, 60 Bond St., Toronto, ON, Canada M5B 1W8.
² Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

View larger version (149K): [in a new window]   Fig. 1A —72-year-old woman with recurrent invasive ductal carcinoma, presented with bloody nipple discharge. Gross tumor size on pathology measured 1.5 cm. Sonogram of left breast shows carcinoma as hypoechoic mass with spiculated margins (arrows) and posterior shadowing (arrowheads). Mass was seen abutting surgical scar and was highly suspicious for malignancy based on sonographic morphology.

View larger version (124K): [in a new window]   Fig. 1B —72-year-old woman with recurrent invasive ductal carcinoma, presented with bloody nipple discharge. Gross tumor size on pathology measured 1.5 cm. Corresponding postsubtraction gadolinium-enhanced fat-saturated T1-weighted sagittal MR image of the left breast shows nonenhancing scar (arrows). No suspicious enhancement was seen.

View larger version (76K): [in a new window]   Fig. 2A —68-year-old woman with invasive lobular carcinoma presented with palpable lump. Gross tumor size on pathology measured 1.5 cm. Mammogram mediolateral-oblique (MLO) projection shows spiculated mass (arrows). Radiopaque photo-marker is seen at site of lump.

View larger version (178K): [in a new window]   Fig. 2B —68-year-old woman with invasive lobular carcinoma presented with palpable lump. Gross tumor size on pathology measured 1.5 cm. Sonogram of right breast shows ill-defined hypoechoic mass with spiculated margins (arrows) and posterior shadowing (arrowheads). Mass is highly suspicious for malignancy based on sonographic features.

View larger version (164K): [in a new window]   Fig. 2C —68-year-old woman with invasive lobular carcinoma presented with palpable lump. Gross tumor size on pathology measured 1.5 cm. Fat-saturated sagittal T2-weighted MRI shows hypointense mass with spiculated margins (arrows), which is morphologically suspicious for malignancy on MRI.

View larger version (107K): [in a new window]   Fig. 2D —68-year-old woman with invasive lobular carcinoma presented with palpable lump. Gross tumor size on pathology measured 1.5 cm. Corresponding postsubtraction gadolinium-enhanced fat-saturated T1-weighted sagittal MRI of left breast shows no enhancement.

View larger version (169K): [in a new window]   Fig. 3 —75-year-old woman with tubular carcinoma. Gross tumor size on pathology measured 8 mm. MRI showed no evidence of lesion enhancement. Sonogram of right breast shows ill-defined hypoechoic mass with spiculated margins (arrow) and posterior shadowing (arrowheads). Mass is highly suspicious for malignancy based on sonographic features.

View larger version (155K): [in a new window]   Fig. 4 —89-year-old woman with invasive ductal carcinoma. Gross tumor size on pathology measured 7 mm. MRI showed no evidence of lesion enhancement. Sonogram of right breast shows ill-defined isoechoic mass (long arrows), taller than wider, with angulated margins (short arrow), and mild posterior shadowing (arrowheads). Mass is highly suspicious for malignancy based on sonographic features.

View larger version (156K): [in a new window]   Fig. 5 —76-year-old woman with multifocal invasive carcinoma showing ductal and lobular features. Gross tumor size of this lesion on pathology measured 6 mm. Sonogram of one of carcinomas, which did not display enhancement on MRI, shows lesion as solid ill-defined hypoechoic mass (arrows) with posterior shadowing (arrowheads). Mass is highly suspicious for malignancy based on sonographic features.

View larger version (166K): [in a new window]   Fig. 6A —48-year-old woman with primary non-Hodgkin's lymphoma of breast presented with a palpable lump. Sonogram of left breast shows hypoechoic, lobulated oval mass, with ill-defined margins (arrows) and posterior acoustic transmission (arrowheads). Mass has indeterminate features on sonography.

View larger version (108K): [in a new window]   Fig. 6B —48-year-old woman with primary non-Hodgkin's lymphoma of breast presented with a palpable lump. Corresponding postsubtraction gadolinium-enhanced fat-saturated T1-weighted sagittal MRI of left breast shows no enhancement of mass (arrows).

View larger version (80K): [in a new window]   Fig. 7 — 63-year-old woman with invasive lobular carcinoma. Gross tumor size on pathology measured 1 cm. Sonogram was negative. Mammogram craniocaudal projection shows spiculated density in posterior third of breast adjacent to chest wall (arrow).

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