Clinical Findings

Changes in the left breast due to treatment. Unremarkable scar. No other unusual findings.

Ultrasound (not shown)

Changes in the left breast due to treatment. No abnormalities.

Fig. 52.1 a,b Digital mammography, MLO view.

Fig. 52.2a–c Contrast-enhanced MRI of the breasts.

Fig. 52.3a–c Contrast-enhanced MRI of the breasts.

Fig. 52.4 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 52.5a,b Signal-to-time curves.

Ultrasound

In the left breast, the only changes observed were related to the earlier treatment for breast cancer. Ultrasound did not show any echo patterns consistent with the enhancement seen in MRI. US BI-RADS right 1/left 2.

Mammography

Mammograms showed an extremely dense parenchymal pattern, ACR type 4. Under these limiting conditions, there were no suspicious findings in the right breast. The left breast showed treatment-induced changes including marked architectural distortions, extending from behind the nipple to the chest wall. There were no signs of lesions or tumor recurrence. Mammograms depicted no microcalcifications. (BI-RADS right 1/left 3) PGMI classification was omitted due to earlier breast conservation therapy of the left breast.

MR Mammography

MRI depicted a linear enhancement close to the chest wall in the imaging slice directly inferior to the nipple. The signal curve in this region showed a strong initial increase of about 100% and a postinitial plateau. The MRI slice directly through the nipple line was normal.

The patient’s history of previous carcinoma and breast conservation therapy, and no mastectomy after tumor relapse, meant that the probability of the linear enhancement seen in MRI representing tumor recurrence was high.

MRI Artifact Category:

2 MRI Density Type: 1

Differential Diagnostic Considerations

Tumor recurrence, focal mastitis, fat necrosis.

Procedure

MR-guided percutaneous biopsy of the circumscribed enhancement near the chest wall in the left breast.

However, the patient declined this intervention and instead follow-up MR mammography was performed 6 months later.

Follow-up MRI after 6 months

Fig. 52.6 Single-slice subtraction image from the follow-up MRI six months later showing residual contrast uptake (arrow). Enhancement of the nipple (asterisk).