Fig. 37.1 Sonography.

Clinical Findings

Implant in right breast. No palpable findings in left breast.

Fig. 37.2a,b Digital mammography, MLO view.

Fig. 37.3a–c Contrast-enhanced MRI of the breasts.

Fig. 37.4a-c Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 37.5a,b Signal-to-time curves.

Ultrasound

Sonography showed normal glandular tissue in the upper outer quadrant of the left breast, with no unusual findings. US BI-RADS left 1.

Mammography

The implant in the right breast limited evaluation. No densities or calcifications were visible. The tissue of the left breast was extremely dense, ACR type 4. Under these limiting conditions, no circumscribed densities and no architectural distortion were detected. No calcifications. BI-RADS right 1/left 1. PGMI is not defined for mammograms including implants.

MR Mammography

Normal MRI of the subpectorally located implant in the right breast.

The parenchyma of the left breast showed diffuse, fine-textured, lobulated enhancement post contrast. Limited by this high vascularization, no circumscribed hypervascularized lesions were visible. Representative signal-time curves in some nodular spotty areas showed a strong initial signal increase followed by a mild washout.

MRI Artifact Category: 2

MRI Density Type: 4

Preliminary Diagnosis

Extensive adenosis of the left breast.

Differential Diagnosis

Diffuse breast cancer.

Procedure

Follow-up MRI in a more suitable week of the menstrual cycle.

Next Step

US-guided blind biopsy (14 gauge) of the left breast at 1 -o’clock,3-o’clock and 5-o’clock positions.

Fig. 37.6 Original MR mammography. Menstrual cycle week 4.

Fig. 37.7 Follow-up MR mammography. Menstrual cycle week 2. Enhancement pattern identical to primary MRI.