AJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Erguvan-Dogan, B.
Right arrow Articles by Dempsey, P. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Erguvan-Dogan, B.
Right arrow Articles by Dempsey, P. J.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?

BI-RADS-MRI: A Primer

Basak Erguvan-Dogan1, Gary J. Whitman1, Anne C. Kushwaha1,2, Michael J. Phelps1,3 and Peter J. Dempsey1

1 Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX 77230.
2 Present address: Southwest Memorial Hospital Breast Center, Houston, TX.
3 Present address: Department of Physiology and Biophysics, Georgetown University, Washington, DC.


Figure 1
View larger version (120K):

[in a new window]
  		Fig. 1A —Focus and foci of enhancement. 49-year-old woman with palpable abnormality in right breast and radiologic findings suggestive of fibrocystic disease. Dynamic contrast-enhanced sagittal 3D fast spoiled gradient-recalled echo image (TR/TE, 7/2; flip angle, 20°; matrix size, 256 x 160; slice thickness, 4 mm; interslice gap, 2 mm; field of view, 20 cm) of left breast with fat suppression shows subcentimeter focus (arrow) of delayed enhancement in upper aspect of right breast.

 

Figure 2
View larger version (108K):

[in a new window]
  		Fig. 1B —Focus and foci of enhancement. 49-year-old woman with palpable abnormality in right breast and radiologic findings suggestive of fibrocystic disease. Multiple foci of enhancement (arrows) throughout right breast. All foci were stable for at least 1.5 years and were considered benign.

 

Figure 3
View larger version (82K):

[in a new window]
  		Fig. 2A —Mass shape may be defined as round, oval, lobulated, or irregular. Maximum slope of increase images obtained in first 2 minutes after contrast injection show malignant masses (arrows) with round (A), oval (B), lobulated (C), and irregular (D) shapes. Irregular accompanied by abnormal nipple enhancement and retraction (arrowhead, D) suggest involvement.

 

Figure 4
View larger version (86K):

[in a new window]
  		Fig. 2B —Mass shape may be defined as round, oval, lobulated, or irregular. Maximum slope of increase images obtained in first 2 minutes after contrast injection show malignant masses (arrows) with round (A), oval (B), lobulated (C), and irregular (D) shapes. Irregular accompanied by abnormal nipple enhancement and retraction (arrowhead, D) suggest involvement.

 

Figure 5
View larger version (117K):

[in a new window]
  		Fig. 2C —Woman with breast cancer. Mass shape may be defined as round, oval, lobulated, or irregular. Maximum slope of increase images obtained in first 2 minutes after contrast injection show malignant masses (arrows) with round (A), oval (B), lobulated (C), and irregular (D) shapes. Irregular accompanied by abnormal nipple enhancement and retraction (arrowhead, D) suggest involvement.

 

Figure 6
View larger version (106K):

[in a new window]
  		Fig. 2D —Woman with breast cancer. Mass shape may be defined as round, oval, lobulated, or irregular. Maximum slope of increase images obtained in first 2 minutes after contrast injection show malignant masses (arrows) with round (A), oval (B), lobulated (C), and irregular (D) shapes. Irregular accompanied by abnormal nipple enhancement and retraction (arrowhead, D) suggest involvement.

 

Figure 7
View larger version (131K):

[in a new window]
  		Fig. 3A —Mass margins can be defined as smooth, irregular, or spiculated. Sagittal 3D fast spoiled gradient-recalled echo (3D FSPGR) image of woman shows oval mass with early peripheral enhancement and smooth margins (arrow) in central aspect of breast. Mass contains central unenhanced area (asterisk) representing necrosis.

 

Figure 8
View larger version (80K):

[in a new window]
  		Fig. 3B —Mass margins can be defined as smooth, irregular, or spiculated. Sagittal 3D FSPGR image shows mass with irregular shape and irregular margins (arrows).

 

Figure 9
View larger version (83K):

[in a new window]
  		Fig. 3C —Mass margins can be defined as smooth, irregular, or spiculated. Sagittal 3D FSPGR image with fat suppression shows round mass with spiculated margins.

 

Figure 10
View larger version (143K):

[in a new window]
  		Fig. 4A —Internal enhancement characteristics of masses. Homogeneous enhancement in 32-year-old woman with peripheral T-cell lymphoma involving right breast. Sagittal maximum slope of increase image shows oval, homogeneously enhanced mass (arrow) with smooth borders in posterior central right aspect of breast representing lymphomatous involvement.

 

Figure 11
View larger version (125K):

[in a new window]
  		Fig. 4B —Internal enhancement characteristics of masses. Heterogeneous enhancement. Sagittal maximum slope of increase image shows irregular borders and heterogeneous internal enhancement at 12-o'clock position. Histopathologic evaluation revealed invasive ductal cancer.

 

Figure 12
View larger version (109K):

[in a new window]
  		Fig. 4C —Internal enhancement characteristics of masses. Rim enhancement. Sagittal 3D fast spoiled gradient-recalled echo image shows two smooth, round masses (arrows) with rim enhancement in central posterior aspect of breast of patient with multicentric breast cancer.

 

Figure 13
View larger version (48K):

[in a new window]
  		Fig. 4D —Internal enhancement characteristics of masses. Dark internal septations. Sagittal maximum slope of increase image shows smooth, oval mass (arrow) with hypointense central septations suggestive of fibroadenoma.

 

Figure 14
View larger version (125K):

[in a new window]
  		Fig. 4E —Internal enhancement characteristics of masses. Central enhanced nidus (arrows) and enhanced internal septum (arrowhead, E). Pathologic assessment of both lesions revealed invasive high-grade ductal carcinoma.

 

Figure 15
View larger version (65K):

[in a new window]
  		Fig. 4F —Internal enhancement characteristics of masses. Central enhanced nidus (arrows) and enhanced internal septum (arrowhead, E). Pathologic assessment of both lesions revealed invasive high-grade ductal carcinoma.

 

Figure 16
View larger version (110K):

[in a new window]
  		Fig. 5A —Nonmasslike enhancements. Woman with focal, clumped, nonmasslike enhancement (arrowheads) in upper and lower outer aspects of left breast representing multicentric ductal cancer. Lesions significantly decreased in size after neoadjuvant chemotherapy.

 

Figure 17
View larger version (85K):

[in a new window]
  		Fig. 5B —Nonmasslike enhancements. Maximum slope of increase image obtained in first 2 minutes after contrast injection shows ductal enhancement (arrows) in upper aspect of right breast. Pathologic result was invasive ductal carcinoma.

 

Figure 18
View larger version (121K):

[in a new window]
  		Fig. 5C —Nonmasslike enhancements. Segmental enhancement (arrows) in lower outer aspect of right breast as shown on sagittal early contrast-enhanced subtraction image. Pathologic result was invasive ductal carcinoma with extensive intraductal component.

 

Figure 19
View larger version (85K):

[in a new window]
  		Fig. 5D —Nonmasslike enhancements. Regional enhancement. Woman with locally advanced breast tumor (arrows) in right breast involving upper outer region of breast. Enhancement diminished on subsequent MR images obtained over course of neoadjuvant chemotherapy, demonstrating response to therapy (not shown).

 

Figure 20
View larger version (56K):

[in a new window]
  		Fig. 6A —Internal enhancement characteristics of nonmasslike enhancements. Sagittal (A) contrast-enhanced dynamic, reconstructed axial (B), and coronal (C) images show clumped enhancement (arrowheads) in upper outer aspect of left breast with right locally advanced breast cancer.

 

Figure 21
View larger version (51K):

[in a new window]
  		Fig. 6B —Internal enhancement characteristics of nonmasslike enhancements. Sagittal (A) contrast-enhanced dynamic, reconstructed axial (B), and coronal (C) images show clumped enhancement (arrowheads) in upper outer aspect of left breast with right locally advanced breast cancer.

 

Figure 22
View larger version (60K):

[in a new window]
  		Fig. 6C —Internal enhancement characteristics of nonmasslike enhancements. Sagittal (A) contrast-enhanced dynamic, reconstructed axial (B), and coronal (C) images show clumped enhancement (arrowheads) in upper outer aspect of left breast with right locally advanced breast cancer.

 

Figure 23
View larger version (8K):

[in a new window]
  		Fig. 6D —Internal enhancement characteristics of nonmasslike enhancements. Dynamic time-intensity curve shows initial rapid upslope followed by continuous increase in signal intensity. MR-guided biopsy revealed fibrocystic disease.

 

Figure 24
View larger version (141K):

[in a new window]
  		Fig. 6E —Internal enhancement characteristics of nonmasslike enhancements. Stippled or punctate enhancement representing hormonal changes in premenopausal woman. Follow-up MR study showed stability of these lesions (not shown).

 

Figure 25
View larger version (86K):

[in a new window]
  		Fig. 7A —Associated findings. Pectoralis muscle or chest wall invasion (thick arrow), skin involvement (thin arrow), and reticular enhancement (asterisk) in woman with T4 breast cancer.

 

Figure 26
View larger version (61K):

[in a new window]
  		Fig. 7B —Associated findings. Unenhanced high signal intensity in ducts. Sagittal T2 (B) and axial T1 (C) images show subareolar dilated ducts (arrows) with areas of high signal intensity (asterisks). These areas represent benign ectatic ducts containing secretion with increased protein content.

 

Figure 27
View larger version (67K):

[in a new window]
  		Fig. 7C —Associated findings. Unenhanced high signal intensity in ducts. Sagittal T2 (B) and axial T1 (C) images show subareolar dilated ducts (arrows) with areas of high signal intensity (asterisks). These areas represent benign ectatic ducts containing secretion with increased protein content.

 

Figure 28
View larger version (90K):

[in a new window]
  		Fig. 7D —Associated findings. MR image of right breast after right segmentectomy for invasive ductal cancer shows abnormal signal voids (arrows) that denotes surgical clips. Deformity and skin thickening (arrowheads) due to surgery and radiation therapy are evident.

 

Figure 29
View larger version (11K):

[in a new window]
  		Fig. 8 —Kinetic curve assessment. Curve interpretation is composed of two sections: I, Initial upslope of curve can be slow (1), medium (2), or rapid (3). This period is first 2 minutes of dynamic scan or until first change in curve, depending on dynamic parameters used. II, Delayed phase comprises period after first 2 minutes or until curve starts to change. Continued increase in enhancement is persistent pattern; steady leveling in enhancement is plateau pattern; and decrease in signal intensity is washout pattern. Washout pattern and plateau pattern occurring early in dynamic study are more likely to be associated with malignancy, whereas persistent pattern is usually detected with benign lesions, such as fibroadenoma, radial scars, and lesions associated with hormonal changes.

 

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by the American Roentgen Ray Society.