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By
Women ImagingWomen Imaging
UnitUnit
Kasr El Aini – Cairo UniversityKasr El Aini – Cairo University

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In certain situations, clinical
examination, mammography and
ultrasonography have some
limitations; due to factors in the
modality or breast parenchyma
MR imaging has an important role in
clinical practice; both in lesion
characterization and tumor staging.
(Khatri rt al, 2001(
A major cost reduction can be
achieved by prevention of
unnecessary surgery, and
additional trauma for the patient.
)Schmitt et al, 2001(

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Sensitive to small abnormalitiesSensitive to small abnormalities..
Effective in dense breastsEffective in dense breasts..
Characterization of breast lesionsCharacterization of breast lesions..
Staging of malignant neoplasmStaging of malignant neoplasm..
Follow-up of patients after different lines of treatmentFollow-up of patients after different lines of treatment
Can image breast implant/ruptureCan image breast implant/rupture..
Can locate occult primary tumor in women whoCan locate occult primary tumor in women who
present by malignant axillary lymph nodepresent by malignant axillary lymph node
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Cannot image calcifications, as tiny calciumCannot image calcifications, as tiny calcium
deposit can indicate early breast cancersdeposit can indicate early breast cancers..
Expensive and not widely availableExpensive and not widely available..
Some patients who are claustrophobic may notSome patients who are claustrophobic may not
tolerate MRItolerate MRI..
Requires use of contrast agentRequires use of contrast agent..
More time-consuming than mammographyMore time-consuming than mammography..
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Suspicious mammographicSuspicious mammographic
findings of malignancy includefindings of malignancy include::
Spiculated or stellate masses with or without
micro-calcifications.
Asymmetrical breast tissue especially when
associated with calcifications.
Areas of architectural distortion.
Pleomorpheic micro-calcifications that are
greater than five in number.

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Patterns of normal parenchymal enhancement
1 No enhancement
2 Minimal or mild enhancement
3 small focal areas of slow or rapid enhancement
4 slow or rapid regional enhancement
5 slow or rapid patchy enhancement
6 Diffuse slow enhancement
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.T2WI Fat suppressedT2WI Fat suppressed T1WIT1WI

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Qualitative methodsQualitative methods Quantitative methodsQuantitative methodsQualitative methodsQualitative methods
11--Early appearance of enhancementEarly appearance of enhancement
22--Peripheral lesion enhancementPeripheral lesion enhancement
33--Border irregularityBorder irregularity
44--Enhancement inhomogeneityEnhancement inhomogeneity
55--converging vesselsconverging vessels
66--Signs of malignancy spreadSigns of malignancy spread

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Quantitative methodsQuantitative methods
11--Enhancement amplitude in theEnhancement amplitude in the
1st two min1st two min..
22--Early peak of enhancementEarly peak of enhancement
curvecurve
33--Early washoutEarly washout
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MalignantMalignant
BenignBenign
22minmin..
77minmin..
<<6060%%>>6060%%

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10. ..
3 minutes
110%
Bilateral
breast
fibroadenoma
s

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7 minutes
70 %
Granulomatus
mastitis

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7 minutes
25 %
Benign
phylloids
tumor
grade II

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4 minutes
70 %
Invasive
Duct
Carcinoma
grade II

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4 minutes
70 %
Multifocal
Invasive
Duct
Carcinoma
grade II
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3min.—105%
4min.– 70%
4min.– 70%
Inflammtory
Carcinomatosis
+
Invasive Duct
Carcinoma

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3min.—105%
7min.– 90%
10min.– 90%
Multicentric
Invasive
Lobular
Carcinoma
grade IV

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4 minutes
85 %
Paget’s
Disease
of the
Nipple

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3 minutes
35 %
Mucinous
Adeno -
carcinoma

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7 minutes
82.5 %
Adenoid
Cystic
Carcinoma

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Post contrast MRM can give relevant additional information
in patients with mammographically dense breasts, or
inhomogeneous tissue on sonography, or both.
Both qualitative and quantitative criteria are needed for
lesion interpretation.
Preoperative post contrast breast MRI has the potential to
reveal mammographically & sonographically hidden
multifocal, multicenteric, or contralateral breast carcinoma

22. Additional diagnostic studies
Breast US &/or DopplerBreast US &/or Doppler
ResultsResults
Normal Benign Indeterminate/Suspicious
Possibly
malignant
6-month follow-up Guided biopsy Surgical biopsy
.Suspicious MammogramsSuspicious Mammograms
Microfocal spot
magnification
Compression &
oblique images
Dynamic post-contrast MR
mammography

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