Enhancement of the nipple-areolar-complex on contrast-enhanced MR imaging of the breast

Abstract

OBJECTIVE: To evaluate patterns of enhancement in the nipple-areolar-complex (NAC) on contrast-enhanced MRI. METHODS: We reviewed the MR images of 37 patients in which enhancement of the NAC was demonstrated on gadolinium-enhanced dynamic fast radiofrequency spoiled gradient recalled echo (fast-SPGR) images. Time intensity profiles derived from signal intensity values were constructed, and findings correlated with histological results. RESULTS: Three types of curve were observed. In the first type seen in adenoma of the nipple, rapid initial increase in signal intensity with an early peak (1 min) occurred followed by gradual washout. In the second type seen in direct invasion from carcinoma, subareolar intracystic papilloma, or Paget's disease, rapid initial increase in signal intensity followed by a more gradual increase or plateau was seen. In the third type seen in carcinoma without nipple invasion, fibrocystic disease and fibroadenoma, a gradual increase in signal intensity was observed throughout the examination period. CONCLUSION: Early and prominent enhancement of the NAC on contrast-enhanced MRImay indicate the presence of a primary lesion in the NAC or secondary involvement by a primary tumor elsewhere in the breast.

Adenoma of the nipple, focusing on the contrast-enhanced magnetic resonance imaging findings: Report of a case

“…Our search using PubMed and Ichushi (a Japanese medical search engine) found only four reports describing how CE-MRI assisted in the diagnosis of adenoma of the nipple, including our case (Table 1). [3][4][5] The time-intensity curve of a benign tumor on CE-MRI generally shows a pattern of gradual increase, as in our patient; however, the other three reports described the same pattern in malignant breast tumors. Contrastenhanced MRI revealed the time-intensity curve of nipple adenoma to peak within 2 min and then gradually decrease thereafter.…”

“…Contrastenhanced MRI revealed the time-intensity curve of nipple adenoma to peak within 2 min and then gradually decrease thereafter. [3][4][5] Matsubayashi et al reported the center of the tumor to show early enhancement with washout on delayed images because it pathologically had weak fi brosis. 4 Isomoto et al also reported that a gradually increasing pattern (benign tumor pattern) of breast cancer was attributed to marked fi brosis of the tumor.…”

“…2 Contrast-enhanced magnetic resonance imaging (CE-MRI) is able to demonstrate a malignant pattern, although adenoma of the nipple is a benign tumor. [3][4][5] We herein report a case focusing on CE-MRI fi ndings and also considering the differences pathologically between our case and others.…”

Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement

“…The term nipple-areolar complex and its acronym (NAC) are frequently used in breast surgery and radiology to refer to the whole 3-dimensional anatomical unit composed of the nipple, external areola, and subareolar and retroareolar (see appendix) tissues. 42 Bricout described this unit as the keystone of the system, where all the intraglandular fibrous septa converge and the absence of any subcutaneous fatty layer at that level results in the close adhesion between skin and glandular tissue. 27 This defining characteristic also permits easier access for RPS to stimulate the nerves concentrated deep at the base of the nipple, where they converge to meet and accompany the separate galactophores (collecting ducts, ampullae) as they pass through the center of the nipple.…”