Significance of breast lesion descriptors in the ACR BI‐RADS MRI lexicon

Abstract

In recent years, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has altered the clinical management for women with breast cancer. In March 2007, the American Cancer Society (ACS) issued a new guideline recommending annual MRI screening for high-risk women. This guideline is expected to substantially increase the number of women each year who receive breast MRI. The diagnosis of breast MRI involves the description of morphological and enhancement kinetics features. To standardize the communication language, the Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon was developed by the American College of Radiology (ACR). In this article, the authors will review various appearances of breast lesions on MRI by using the standardized terms of the ACR BI-RADS MRI lexicon. The purpose is to familiarize all medical professionals with the breast MRI lexicon because the use of this imaging modality is rapidly growing in the field of breast disease. By using this common language, a comprehensive analysis of both morphological and kinetic features used in image interpretation will help radiologists and other clinicians to communicate more clearly and consistently. This may, in turn, help physicians and patients to jointly select an appropriate management protocol for each patient's clinical situation. In March 2007, the American Cancer Society (ACS) issued a new guideline recommending annual screening for high-risk women using breast magnetic resonance imaging (MRI). MRI is recommended as an adjunct to mammography for women with a lifetime risk of 20%-25% or greater, including women with a strong family history of breast or ovarian cancer and women who had been treated for Hodgkin disease. 1 For women with a 15% to 20% lifetime risk, based on the analysis of multiple risk factors such as a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography, the ACS suggested that the screening decisions should be made on a case-by-case basis. 2 Breast MRI can alter the clinical management for a sizable fraction of women with early stage breast cancer and help in determining the optimal local treatment. [3][4][5][6] Kuhl et al concluded that MRI screening of women with a history of familial or hereditary breast cancer can achieve a significantly higher sensitivity

Radiological and clinical features of adult non-puerperal mastitis

“…However, these findings always present dominant lesions surrounded by multiple, small, enhancing foci [22,23], which is slightly different from our findings (multiple Radiological and clinical features of adult non-puerperal mastitis regional non-mass-like lesions). Clustered enhancements on MRI, such as clustered focal area, ductal or segmental enhancements, are observed more frequently in ductal carcinoma in situ (DCIS) [16,24]; but in our study, clustered rim-like enhancements were found in 29 patients (63.1%). Rim-like enhancement on MRI was reported to be more frequent in malignant breast diseases [16,24,25], especially for mass-like lesions, as this is related to a large area of tumour ischaemic necrosis due to the rapid growth of a malignant tumour.…”

“…Clustered enhancements on MRI, such as clustered focal area, ductal or segmental enhancements, are observed more frequently in ductal carcinoma in situ (DCIS) [16,24]; but in our study, clustered rim-like enhancements were found in 29 patients (63.1%). Rim-like enhancement on MRI was reported to be more frequent in malignant breast diseases [16,24,25], especially for mass-like lesions, as this is related to a large area of tumour ischaemic necrosis due to the rapid growth of a malignant tumour. However, if treatment is delayed or if it is inadequate in mastitis, these rim-like enhancements can cause the formation of abscesses near mammary ducts because of the necrosis present in tissue cells.…”

Computer-Aided Diagnosis Scheme for Distinguishing Between Benign and Malignant Masses in Breast DCE-MRI

“…The initial enhancement phase usually refers to an increase in signal intensity within the first 2 min after contrast injection [18,19]. Therefore, for the segmentation of a mass region, the rectangular region of interest (ROI), which included an entire mass, was selected manually on the DCE-MRI image after 2 min by an experienced radiological technologist.…”

“…These objective features were as follows: (1) the roundness of the shape; (2) the irregularity of the shape; (3) the smoothness of the margin; (4) the irregularity of the margin; (5) the extent of distribution toward the nipple; (6) the heterogeneity of the enhancement pattern; (7) the degree of rim enhancement; (8) the change in signal intensity from 0 to 1 min; (9) the change in signal intensity from 1 to 2 min; (10) the change in signal intensity from 0 to 2 min; and (11) the change in signal intensity from 2 to 5 min. Objective features 1-7, which are concerned with the image features, were extracted from the DCE-MRI images at 2 min, that is because BI-RADS recommends a morphologic evaluation at the early phase within 2 min [18,19].…”

Can semi-quantitative evaluation of uncertain (type II) time-intensity curves improve diagnosis in breast DCE-MRI?

“…The vascularisation of the malignant lesions resulting from neo-vessels, that are the basis of exponential tumour growth, is one of the major reasons that dynamic features of MRI have played a crucial role in breast cancer for a decade [7][8][9][10][11][12][13][14][15][16][17][18][19].…”