Clinical Findings

No findings.

Sonography

No findings (not shown).

Fig. 3.1 a,b Digital mammography of both breasts, MLO view.

Fig. 3.2a–c Contrast-enhanced MRI of the breasts.

Fig. 3.3 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 3.4a,b Signal-to-time curves.

Ultrasound

Ultrasound showed no suspicious changes (not shown).

Mammography

Bilaterally symmetric, extremely dense parenchymal pattern, ACR type 4. Within the limitations of these conditions, there were no abnormal findings in the left breast central area-where MRI findings are significant-or anywhere else. There is no hyperdensity, no mass, no architectural distortion. No microcalcifications corresponding to the linear enhancement observed in MRI (BI-RADS right 1/left 1). PGMI: MLO view P.

MR Mammography

There is linear and partially dendritic enhancement, likely representing a milk duct, visible in the central sections of the left breast. Signal-time curves are nonspecific. No further observations.

MRI Artifact Category: 1

MRI Density Type: 1

Preliminary Diagnosis

DCIS.

Differential Diagnosis

Segmental papillomatosis, inflammation of the milk ducts.

Procedure

Histological verification of the suspicious findings in MRI, preferably with MR-guided percutaneous vacuum biopsy to avoid open biopsy.

Fig. 3.5a–d Documentation of the MR-guided vacuum biopsy: T1-weighted precontrast image of the left breast positioned within the stereotactic device (a). Precise reproducibility of the linear enhancement in subtraction image (b). Position of the biopsy needle after removal of 20 core biopsies (11 gauge) (c). Documentation of parts of the enhancing area in a second contrast-enhanced MRI sequence (subtraction image) (d).