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Background Parenchymal Enhancement (MR)
Regina J. Hooley, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Background parenchymal enhancement (BPE)
              • Definitions

                • Enhancement of healthy premenopausal breast tissue in cyclical and variable manner; typically symmetric
                • Normal enhancement of fibroglandular tissue (FGT) assessed on 1st postcontrast images (90-180 seconds post injection)
                  • No uniform standard for BPE assessment
                • Described as minimal, mild, moderate, or marked
                  • Refers to both volume and intensity of enhancement
                  • Usually determined by visual qualitative assessment by radiologist (variable inter- and intra-reader agreement)
                  • Automated quantitative computer algorithms/software
                    • May be more reliable and reproducible, but further study needed
                • Typically bilateral, symmetric, peripheral nonmass enhancement (NME); may be focal, regional, or diffuse
                • Separately describe breast composition: Almost entirely fat; scattered, heterogeneous, or extreme FGT

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. Arasu VA et al: Population-based assessment of the association between magnetic resonance Imaging Background Parenchymal Enhancement and Future Primary Breast Cancer Risk. J Clin Oncol. JCO1800378, 2019
                                        2. Brooks JD et al: MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer. 143(4):823-830, 2018
                                        3. Fan M et al: DCE-MRI texture analysis with tumor subregion partitioning for predicting Ki-67 status of estrogen receptor-positive breast cancers. J Magn Reson Imaging. 48(1):237-247, 2018
                                        4. Grimm LJ et al: Relationship between background parenchymal enhancement on high-risk screening MRI and future breast cancer risk. Acad Radiol. ePub, 2018
                                        5. Ha R et al: Evaluation of association between degree of background parenchymal enhancement on MRI and breast cancer subtype. Clin Imaging. 51:307-310, 2018
                                        6. Heller SL et al: Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics. 38(4):983-996, 2018
                                        7. Jung Y et al: Quantitative analysis of background parenchymal enhancement in whole breast on MRI: Influence of menstrual cycle and comparison with a qualitative analysis. Eur J Radiol. 103:84-89, 2018
                                        8. Oh SJ et al: Relationship between background parenchymal enhancement on breast MRI and pathological tumor response in breast cancer patients receiving neoadjuvant chemotherapy. Br J Radiol. 20170550, 2018
                                        9. Ray KM et al: Effect of background parenchymal enhancement on breast MR imaging Interpretive performance in community-based practices. Radiology. 286(3):822-829, 2018
                                        10. Shin GW et al: Role of dynamic contrast-enhanced MRI in evaluating the association between contralateral parenchymal enhancement and survival outcome in ER-positive, HER2-negative, node-negative invasive breast cancer. J Magn Reson Imaging. ePub, 2018
                                        11. Sung JS et al: Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat. ePub, 2018
                                        12. van der Velden BHM et al: Contralateral parenchymal enhancement on dynamic contrast-enhanced MRI reproduces as a biomarker of survival in ER-positive/HER2-negative breast cancer patients. Eur Radiol. ePub, 2018
                                        13. Bae MS et al: Association of preoperative breast MRI features with locoregional recurrence after breast conservation therapy. Acta Radiol. 284185117723041, 2017
                                        14. Bignotti B et al: Evaluation of background parenchymal enhancement on breast MRI: a systematic review. Br J Radiol. 90(1070):20160542, 2017
                                        15. Fan M et al: Radiomic analysis of DCE-MRI for prediction of response to neoadjuvant chemotherapy in breast cancer patients. Eur J Radiol. ePub, 2017
                                        16. Heacock L et al: Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness. J Magn Reson Imaging. ePub, 2017
                                        17. Kim EJ et al: Diagnostic Performance of and Breast Tissue Changes at Early Breast MR Imaging Surveillance in Women after Breast Conservation Therapy. Radiology. 162123, 2017
                                        18. Mema E et al: Does breast MRI background parenchymal enhancement indicate metabolic activity? Qualitative and 3D quantitative computer imaging analysis. J Magn Reson Imaging. ePub, 2017
                                        19. Tomida T et al: Contrast Enhancement in Breast Cancer and Background Mammary-Gland Tissue During the Super-Early Phase of Dynamic Breast Magnetic Resonance Imaging. Acad Radiol. ePub, 2017
                                        20. Wu J et al: Identifying relations between imaging phenotypes and molecular subtypes of breast cancer: Model discovery and external validation. J Magn Reson Imaging. ePub, 2017
                                        21. Wu S et al: DCE-MRI Background Parenchymal Enhancement Quantified from an Early versus Delayed Post-contrast Sequence: Association with Breast Cancer Presence. Sci Rep. 7(1):2115, 2017
                                        22. Preibsch H et al: Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response. Eur Radiol. 26(6):1590-6, 2016
                                        23. Dontchos BN et al: Are Qualitative Assessments of Background Parenchymal Enhancement, Amount of Fibroglandular Tissue on MR Images, and Mammographic Density Associated with Breast Cancer Risk? Radiology. 276(2):371-80, 2015
                                        24. Giess CS et al: Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics. 34(1):234-47, 2014
                                        25. Kim SA et al: Background Parenchymal Signal Enhancement Ratio at Preoperative MR Imaging: Association with Subsequent Local Recurrence in Patients with Ductal Carcinoma in Situ after Breast Conservation Surgery. Radiology. 270(3):699-707, 2014
                                        26. Melsaether A et al: Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training. AJR Am J Roentgenol. 203(1):209-15, 2014
                                        27. Giess CS et al: Patterns of Nonmasslike Enhancement at Screening Breast MR Imaging of High-Risk Premenopausal Women. Radiographics. 33(5):1343-60, 2013
                                        28. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                        29. King V et al: Effect of aromatase inhibitors on background parenchymal enhancement and amount of fibroglandular tissue at breast MR imaging. Radiology. 264(3):670-8, 2012
                                        30. King V et al: Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol. 22(12):2641-7, 2012
                                        31. King V et al: Impact of tamoxifen on amount of fibroglandular tissue, background parenchymal enhancement, and cysts on breast magnetic resonance imaging. Breast J. 18(6):527-34, 2012
                                        32. Mousa NA et al: The effect of acute aromatase inhibition on breast parenchymal enhancement in magnetic resonance imaging: a prospective pilot clinical trial. Menopause. 19(4):420-5, 2012
                                        33. Abramovici G et al: Screening breast MR imaging: comparison of interpretation of baseline and annual follow-up studies. Radiology. 259(1):85-91, 2011
                                        34. Hambly NM et al: Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol. 196(1):218-24, 2011
                                        35. King V et al: Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology. 260(1):50-60, 2011
                                        36. Delille JP et al: Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: perfusion imaging, signal enhancement, and influence of the T1 relaxation time of breast tissue. Breast J. 11(4):236-41, 2005
                                        37. Ramakrishnan R et al: Morphological changes in breast tissue with menstrual cycle. Mod Pathol. 15(12):1348-56, 2002
                                        38. Kuhl CK et al: Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology. 203(1):137-44, 1997
                                        39. Müller-Schimpfle M et al: Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology. 203(1):145-9, 1997
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Background parenchymal enhancement (BPE)
                                                    • Definitions

                                                      • Enhancement of healthy premenopausal breast tissue in cyclical and variable manner; typically symmetric
                                                      • Normal enhancement of fibroglandular tissue (FGT) assessed on 1st postcontrast images (90-180 seconds post injection)
                                                        • No uniform standard for BPE assessment
                                                      • Described as minimal, mild, moderate, or marked
                                                        • Refers to both volume and intensity of enhancement
                                                        • Usually determined by visual qualitative assessment by radiologist (variable inter- and intra-reader agreement)
                                                        • Automated quantitative computer algorithms/software
                                                          • May be more reliable and reproducible, but further study needed
                                                      • Typically bilateral, symmetric, peripheral nonmass enhancement (NME); may be focal, regional, or diffuse
                                                      • Separately describe breast composition: Almost entirely fat; scattered, heterogeneous, or extreme FGT

                                                    IMAGING

                                                    • General Features

                                                      • Mammographic Findings

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. Arasu VA et al: Population-based assessment of the association between magnetic resonance Imaging Background Parenchymal Enhancement and Future Primary Breast Cancer Risk. J Clin Oncol. JCO1800378, 2019
                                                                              2. Brooks JD et al: MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer. 143(4):823-830, 2018
                                                                              3. Fan M et al: DCE-MRI texture analysis with tumor subregion partitioning for predicting Ki-67 status of estrogen receptor-positive breast cancers. J Magn Reson Imaging. 48(1):237-247, 2018
                                                                              4. Grimm LJ et al: Relationship between background parenchymal enhancement on high-risk screening MRI and future breast cancer risk. Acad Radiol. ePub, 2018
                                                                              5. Ha R et al: Evaluation of association between degree of background parenchymal enhancement on MRI and breast cancer subtype. Clin Imaging. 51:307-310, 2018
                                                                              6. Heller SL et al: Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics. 38(4):983-996, 2018
                                                                              7. Jung Y et al: Quantitative analysis of background parenchymal enhancement in whole breast on MRI: Influence of menstrual cycle and comparison with a qualitative analysis. Eur J Radiol. 103:84-89, 2018
                                                                              8. Oh SJ et al: Relationship between background parenchymal enhancement on breast MRI and pathological tumor response in breast cancer patients receiving neoadjuvant chemotherapy. Br J Radiol. 20170550, 2018
                                                                              9. Ray KM et al: Effect of background parenchymal enhancement on breast MR imaging Interpretive performance in community-based practices. Radiology. 286(3):822-829, 2018
                                                                              10. Shin GW et al: Role of dynamic contrast-enhanced MRI in evaluating the association between contralateral parenchymal enhancement and survival outcome in ER-positive, HER2-negative, node-negative invasive breast cancer. J Magn Reson Imaging. ePub, 2018
                                                                              11. Sung JS et al: Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat. ePub, 2018
                                                                              12. van der Velden BHM et al: Contralateral parenchymal enhancement on dynamic contrast-enhanced MRI reproduces as a biomarker of survival in ER-positive/HER2-negative breast cancer patients. Eur Radiol. ePub, 2018
                                                                              13. Bae MS et al: Association of preoperative breast MRI features with locoregional recurrence after breast conservation therapy. Acta Radiol. 284185117723041, 2017
                                                                              14. Bignotti B et al: Evaluation of background parenchymal enhancement on breast MRI: a systematic review. Br J Radiol. 90(1070):20160542, 2017
                                                                              15. Fan M et al: Radiomic analysis of DCE-MRI for prediction of response to neoadjuvant chemotherapy in breast cancer patients. Eur J Radiol. ePub, 2017
                                                                              16. Heacock L et al: Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness. J Magn Reson Imaging. ePub, 2017
                                                                              17. Kim EJ et al: Diagnostic Performance of and Breast Tissue Changes at Early Breast MR Imaging Surveillance in Women after Breast Conservation Therapy. Radiology. 162123, 2017
                                                                              18. Mema E et al: Does breast MRI background parenchymal enhancement indicate metabolic activity? Qualitative and 3D quantitative computer imaging analysis. J Magn Reson Imaging. ePub, 2017
                                                                              19. Tomida T et al: Contrast Enhancement in Breast Cancer and Background Mammary-Gland Tissue During the Super-Early Phase of Dynamic Breast Magnetic Resonance Imaging. Acad Radiol. ePub, 2017
                                                                              20. Wu J et al: Identifying relations between imaging phenotypes and molecular subtypes of breast cancer: Model discovery and external validation. J Magn Reson Imaging. ePub, 2017
                                                                              21. Wu S et al: DCE-MRI Background Parenchymal Enhancement Quantified from an Early versus Delayed Post-contrast Sequence: Association with Breast Cancer Presence. Sci Rep. 7(1):2115, 2017
                                                                              22. Preibsch H et al: Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response. Eur Radiol. 26(6):1590-6, 2016
                                                                              23. Dontchos BN et al: Are Qualitative Assessments of Background Parenchymal Enhancement, Amount of Fibroglandular Tissue on MR Images, and Mammographic Density Associated with Breast Cancer Risk? Radiology. 276(2):371-80, 2015
                                                                              24. Giess CS et al: Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics. 34(1):234-47, 2014
                                                                              25. Kim SA et al: Background Parenchymal Signal Enhancement Ratio at Preoperative MR Imaging: Association with Subsequent Local Recurrence in Patients with Ductal Carcinoma in Situ after Breast Conservation Surgery. Radiology. 270(3):699-707, 2014
                                                                              26. Melsaether A et al: Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training. AJR Am J Roentgenol. 203(1):209-15, 2014
                                                                              27. Giess CS et al: Patterns of Nonmasslike Enhancement at Screening Breast MR Imaging of High-Risk Premenopausal Women. Radiographics. 33(5):1343-60, 2013
                                                                              28. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                                                              29. King V et al: Effect of aromatase inhibitors on background parenchymal enhancement and amount of fibroglandular tissue at breast MR imaging. Radiology. 264(3):670-8, 2012
                                                                              30. King V et al: Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol. 22(12):2641-7, 2012
                                                                              31. King V et al: Impact of tamoxifen on amount of fibroglandular tissue, background parenchymal enhancement, and cysts on breast magnetic resonance imaging. Breast J. 18(6):527-34, 2012
                                                                              32. Mousa NA et al: The effect of acute aromatase inhibition on breast parenchymal enhancement in magnetic resonance imaging: a prospective pilot clinical trial. Menopause. 19(4):420-5, 2012
                                                                              33. Abramovici G et al: Screening breast MR imaging: comparison of interpretation of baseline and annual follow-up studies. Radiology. 259(1):85-91, 2011
                                                                              34. Hambly NM et al: Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol. 196(1):218-24, 2011
                                                                              35. King V et al: Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology. 260(1):50-60, 2011
                                                                              36. Delille JP et al: Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: perfusion imaging, signal enhancement, and influence of the T1 relaxation time of breast tissue. Breast J. 11(4):236-41, 2005
                                                                              37. Ramakrishnan R et al: Morphological changes in breast tissue with menstrual cycle. Mod Pathol. 15(12):1348-56, 2002
                                                                              38. Kuhl CK et al: Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology. 203(1):137-44, 1997
                                                                              39. Müller-Schimpfle M et al: Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology. 203(1):145-9, 1997