Fig. 54.1 a,b Ultrasound.

Clinical Findings

Dense, nodular parenchyma, but no circumscribed lumps.

Fig. 54.2a,b Digital mammography, MLO view.

Fig. 54.3a,b Digital mammography, CC view.

Fig. 54.4a–c Contrast-enhanced MR mammography.

Fig. 54.5a–c Contrast-enhanced MR mammography.

Fig. 54.6 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 54.7a,b Signal-to-time curves.

Fig. 54.8a,b Signal-to-time curves.

Ultrasound

Ultrasound showed an inhomogeneous, partially hypoechoic lesion measuring 3 cm × 1.5 cm in the upper outer quadrant of the right breast. The distal echo pattern was indeterminate. Multiple cysts were also seen in both breasts. US BI-RADS right 3.

Mammography

The parenchyma was bilaterally symmetric and extremely dense, ACR type 4. Under these limiting conditions, mammography showed no suspect densities or masses. No architectural distortion or calcifications. BI-RADS right 1/left 1. PGMI: CC view P; MLO view G (bilateral skin folds).

MR Mammography

MRI depicted an inhomogeneous enhancing lesion 3 cm × 1.5 cm in size in the upper outer quadrant of the right breast, near the areola. This lesion had very high initial signal increase and postinitial washout. The signal in T2-weighted imaging was partially increased. There were multiple cysts of diameter up to 4 cm in both breasts.

MRI Artifact Category: 1

MRI Density Type: 2

Differential Diagnosis

Carcinoma, papilloma, fibroadenoma.

Procedure

Fig. 54.9a,b US-guided core biopsy (pre-fire, post-fire)

Fig. 54.10a–f MR-guided localization to determine the precise extent of the tumor on the chest wall side. Consecutive subtraction images from the middle of the lesion to its caudal limit (a-d). Precontrast imaging of the tumor at its caudal border (e) and documentation of the correctly positioned hook-wire (f).