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Breast MRI Using the VIBE Sequence: Clustered Ring Enhancement in the Differential Diagnosis of Lesions Showing Non-Masslike Enhancement

Mitsuhiro Tozaki1,2, Takao Igarashi2 and Kunihiko Fukuda2

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, Japan 105-8461.


Figure 1
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  		Fig. 1A —54-year-old woman with suspicious microcalcifications on mammography. Coronal first contrast-enhanced T1-weighted MR image of left breast shows regional enhancement in upper outer quadrant (arrow). Lesion indicates heterogeneous enhancement inside of which minute ring enhancements are seen clustered (clustered ring enhancement).

 

Figure 2
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  		Fig. 1B —54-year-old woman with suspicious microcalcifications on mammography. Photomicrograph of histopathologic specimen shows ductal carcinoma in situ (DCIS) with intraluminal necrosis and microcalcifications. Clustered ring enhancement corresponds to periductal stroma. However, intraductal cancer cell involvement in enhancement cannot be ruled out.

 

Figure 3
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  		Fig. 2A —48-year-old woman who presented with bloody nipple discharge of left breast. No microcalcifications were detectable on mammography. Coronal first contrast-enhanced T1-weighted MR image shows segmental heterogeneous enhancement in lower region of left breast (arrow).

 

Figure 4
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  		Fig. 2B —48-year-old woman who presented with bloody nipple discharge of left breast. No microcalcifications were detectable on mammography. Transverse third contrast-enhanced T1-weighted MR image shows clustered ring enhancement (arrow).

 

Figure 5
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  		Fig. 2C —48-year-old woman who presented with bloody nipple discharge of left breast. No microcalcifications were detectable on mammography. Photomicrograph of histopathologic specimen shows ductal carcinoma in situ (DCIS) with micropapillary pattern. Clustered ring enhancement corresponds to periductal stroma.

 

Figure 6
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  		Fig. 3A —42-year-old woman with suspicious density on mammography. Sagittal multiplanar reconstruction of first contrast-enhanced T1-weighted MR image shows focal enhancement in upper region of left breast (arrow).

 

Figure 7
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  		Fig. 3B —42-year-old woman with suspicious density on mammography. Transverse multiplanar reconstruction of first contrast-enhanced T1-weighted MR image shows nonenhancing internal septations (arrow).

 

Figure 8
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  		Fig. 3C —42-year-old woman with suspicious density on mammography. Transverse third contrast-enhanced T1-weighted MR image shows heterogeneous internal enhancement with clustered ring enhancement (arrows). Histologic evaluation of lumpectomy specimen revealed 20-mm ductal carcinoma in situ (DCIS) within 5-mm invasive ductal carcinoma. Nonenhancing internal septations corresponded to normal gland tissue.

 

Figure 9
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  		Fig. 4A —38-year-old woman with microcalcifications on mammography. Coronal first contrast-enhanced T1-weighted MR image of right breast shows focal enhancement in upper outer quadrant (arrow).

 

Figure 10
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  		Fig. 4B —38-year-old woman with microcalcifications on mammography. Coronal first contrast-enhanced T1-weighted MR image of right breast shows clustered ring enhancement (arrow).

 

Figure 11
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  		Fig. 4C —38-year-old woman with microcalcifications on mammography. Coronal third contrast-enhanced T1-weighted MR image shows persistent pattern (arrow). Lesion shows aggregate of enhancing foci in cobblestone pattern (clumped enhancement), and enhancing foci constitute ringlike enhancement pattern. This type of clustered ring enhancement is thought to be subtype of clumped enhancement. Histologic evaluation of excisional biopsy specimen revealed fibrocystic disease. Clustered ring enhancement corresponded to dilated ducts within microcalcifications.

 

Figure 12
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  		Fig. 5A —43-year-old woman with microcalcifications on mammography. Coronal first contrast-enhanced T1-weighted MR image of right breast shows regional heterogeneous enhancement (arrows).

 

Figure 13
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  		Fig. 5B —43-year-old woman with microcalcifications on mammography. Transverse multiplanar reconstruction of first contrast-enhanced T1-weighted MR image shows regional heterogeneous enhancement without clustered ring enhancement (arrows).

 

Figure 14
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  		Fig. 5C —43-year-old woman with microcalcifications on mammography. Transverse third contrast-enhanced T1-weighted MR image shows persistent enhancing region without clustered ring enhancement (arrows). Histologic evaluation of excisional biopsy specimen revealed fibrocystic disease.

 

Figure 15
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  		Fig. 6A —40-year-old woman who presented with bloody nipple discharge of left breast. No microcalcifications were detectable on mammography. Transverse multiplanar reconstruction of first contrast-enhanced T1-weighted MR image shows segmental enhancement with clumped internal architecture (arrows).

 

Figure 16
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  		Fig. 6B —40-year-old woman who presented with bloody nipple discharge of left breast. No microcalcifications were detectable on mammography. Transverse third contrast-enhanced T1-weighted MR image shows clustered ring enhancement after washout (arrows). This type of clustered ring enhancement is thought to be subtype of clumped enhancement. Histologic evaluation of mastectomy specimen revealed ductal carcinoma in situ (DCIS). One physiopathologic explanation is that intraductal carcinoma with abundant blood supply exhibits washout pattern and contrast medium that accumulates in periductal stroma or ductal wall contributes to this phenomenon.

 

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