CLUSTERED BREAST MICROCALCIFICATIONS - EVALUATION BY DYNAMIC CONTRAST-ENHANCED SUBTRACTION MRI

Objective: Our goal was to evaluate dynamic contrast-enhanced subtract ion MRI in the diagnosis of isolated clustered calcifications of the b reast. Materials and Methods: One hundred seventy-two patients underwe nt surgical biopsy for isolated clustered breast calcifications. Their mammograms showed round (n = 88) or linear/irregular (n = 84) microca lcifications. All patients had a preoperative Gd-DOTA-enhanced subtrac tion dynamic study. Any early contrast enhancement in the breast paren chyma concomitant with early enhancement of normal vessels was conside red positive. Results: Fifty-eight in situ carcinomas, 22 invasive car cinomas, and 92 benign lesions were found at histological analysis. Dy namic MR sequences showed early contrast enhancement in 76 of 80 malig nant lesions (sensitivity 95%) and in 45 of 92 benign lesions (specifi city 51%). Two invasive and two intraductal carcinomas did not show ea rly contrast enhancement. Three independent observers agreed in rating early contrast enhancement in 143 of 172 lesions. Conclusion: Poor sp ecificity limits the diagnostic accuracy of dynamic contrast-enhanced subtraction MRI in distinguishing benign from malignant microcalcifica tions on mammography.