Figure 1

History: 30 year old female presented with a palpable abnormality in the right breast. Ultrasound showed an area of heterogeneous echogenicity (figure 1). The mammogram showed dense breasts with a small area of microcalcifications (figure 2). Biopsy showed carcinoma. The patient was then referred to Main Street Radiology for Breast MRI to determine the extent of cancer for surgical planning.

Figure 2

Findings: Post contrast axial and sagittal images (figures 3 and 4) demonstrate an area of intense early arterial phase enhancement (arrows) which corresponds to the sonographic finding. Although the mass is very posterior in location, there is preservation of the fat plane between the mass and the chest wall indicating the absence of chest wall invasion.

The patient underwent lumpectomy and was found to have a 2.5 cm invasive ductal carcinoma.

Figure 3

Discussion: A meta-analysis of 16 studies demonstrated the sensitivity of 95% and a specificity of 67% for Breast MRI (Hrung JM, Acad Radiol 1999:6:387-397), significantly higher than mammography or ultrasound.

Figure 4

At Main Street Radiology, the routine Breast MRI includes images of both breast acquired simultaneously both before and at multiple time-points after the administration of IV contrast. Both the morphology as well as the dynamic enhancement characteristics of lesions are evaluated.

Figure 5

Rapid enhancement and de-enhancement is typical for malignancy (Type III curve on Figure 5). The rapid initial enhancement rate of malignancies is likely due to tumor angiogenesis. Malignant lesions are known to require the recruitment of a large concentration of tumor neo-vessels to permit their continued growth beyond a few millimeters.