Clinical Findings

Normal.

Fig. 73.1 Ultrasound.

Fig. 73.2 Color-coded Doppler sonography

Fig. 73.3a,b Digital mammography, CC view.

Fig. 73.4a,b Digital mammography, MLO view.

Fig. 73.5a–c Contrast-enhanced MRI of the breasts.

Fig. 73.6 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 73.7a–c Enlarged view of lesion; signal-to-time curves.

Ultrasound

Within the upper inner quadrant of the left breast between the ventral edge of the parenchyma and the subcutaneous fatty tissue, ultrasound showed an irregular, hypoechoic lesion measuring 8 mm with inhomogeneous echo texture. There were signs of a slight distortion of ligamental structures. Moreover, the lesion showed marked internal signal increase in color-coded duplex sonography. US BI-RADS 4.

Mammography

Mammography showed bilaterally symmetric, extremely dense parenchyma, ACR type 4. Under these limiting conditions, there were no unusual findings, particularly in the inner quadrants of the left breast (the area of the sonographic findings). No densities, no lesions, no architectural distortions, and no microcalcifications were detected. BI-RADS right 1/left 1. PGMI: CC view P; MLO view G (inframammary fold).

MR Mammography

MRI depicted a single, ill-defined hypervascularized lesion in the upper inner quadrant of the left breast, consistent with the sonographic findings. There was a slight central reduction of signal and overall inhomogeneous enhancement (ring enhancement? septations?). The signal-time curves were non-specific.

MRI Artifact Category: 1

MRI Density Type: 1

Differential Diagnosis

Carcinoma, focal adenosis, papilloma, adenoma.

Procedure

Fig. 73.8a,b US-guided core biopsy (pre-fire, post-fire)

Fig. 73.9a–d MR-guided vacuum biopsy (precontrast, subtraction after contrast administration, T1-weighted image after biopsy, and documentation of complete removal of the lesion after further contrast administration.