MRI of Lump in Breast

44-year-old patient presented with complaint of lump in right breast for four months.

Figure 1. T2W image shows heterogeneous hyperintense mass in right breast.

Figure 2. T1W shows heterogeneous hyperintense mass in right breast.

Figure 3. STIR image shows heterogeneous hyperintense mass in right breast.

Figure 4. DWI shows restricted diffusion.

Figure 5. MR spectroscopy shows high choline level in sol in right breast.

Findings showed a large mass in the right breast with low signal on T1WI and hyperintense on T2W and STIR images.

Breast MRI is a rapidly growing field, especially in the assessment of high-risk women.

Mass enhancement, shape: round, oval, lobulated, irregular

Enhancement kinetics, washout, plateau, persistent (caveat: papillomas and lymph nodes washout)

BIRADS IIIA and IIIB: Follow for 2 years (6 months, 1 year, 2 year), whereas mammo every 3 years; 24% of 1st time MRI given BI-RADS III; 0%–10% cancer rate (3% MSKCC: small invasive cancers, and DCIS)

It is important to remember that, as most MRIs of the breast are performed on high risk population, 17% of smooth masses on the first  MRI were cancer.

Clinical history and correlation with mammography is always useful and can reduce assignment of BIRADS III category.

Positive predictive value higher the closer the lesion is to the index cancer.

Biopsy to get histological diagnosis no matter how suspicious because result is Mx.

Indications for breast MRI per ACR guidelines.

Indications for breast MRI per ACS.

MRI features and PPV.

Caveat: if mammography or ultrasound is positive or palpable finding need to treat/biopsy/excise despite negative MRI.