DIAGNOSTIC PERFORMANCE-CHARACTERISTICS OF ARCHITECTURAL FEATURES REVEALED BY HIGH-SPATIAL-RESOLUTION MR-IMAGING OF THE BREAST

OBJECTIVE. Our objective was twofold: to determine which architectural features revealed by high spatial-resolution MR imaging of the breast contribute to diagnostic accuracy and to evaluate the diagnostic perf ormance characteristics of those architectural features. MATERIALS AND METHODS. Eligible patients with suspicious mammographic or palpable f indings or both underwent MR imaging, Ninety-three patients whose MR i mages revealed lesions that corresponded to the mammographically visib le or palpable findings were included in the study. Patients were exam ined with sagittal T1-weighted spin-echo MR imaging, fat-saturated T2- weighted fast spin-echo MR imaging, and dynamically enhanced fat-satur ated fast gradient-echo MR imaging. All patients underwent subsequent excisional biopsy or cyst aspiration. Lesions were identified initiall y by an experienced radiologist who was aware of the patient's clinica l or mammographic information. Two radiologists who were unaware of th e patients' histories and who had less experience in MR imaging of the breast then independently evaluated each lesion for the architectural features and predicted each lesion's potential for malignancy. RESULT S. Architectural features that were highly predictive of benign diseas e included smooth or lobulated borders (97-100%), the absence of mass enhancement (100%), and enhancement that was less than the enhancement of surrounding breast fibroglandular tissue (93-100%), Nonenhancing i nternal septations were specific for the diagnosis of fibroadenoma. Ar chitectural features that were highly predictive of malignant disease included spiculated borders (76-88%) and peripheral rim enhancement in the presence of central lesion enhancement (79-92%). CONCLUSION. Arch itectural features revealed by high spatial-resolution MR imaging of t he breast can help distinguish benign from malignant disease.