Nonmass enhancement (NME): MR enhancement distinct from parenchyma but not in mass or focus
Distribution types of NME: Focal area, regional, diffuse, linear, and segmental
Focal area: NME in confined area of breast; 5 mm up to < 25% of volume of quadrant
Regional: NME occupying large portion of breast tissue; ≥ 25% of 1 quadrant to > 1 quadrant; geographic
May show interspersed normal tissue; single or multiple regions of NME can be seen
Multiple regions: Enhancement in at least 2 large volumes of breast tissue separated by normal tissue; geographic and patchy
Diffuse: Enhancement throughout breast
Distinguish from linear and segmental distribution types
Linear: Enhancement in line that branches, suggests duct
Segmental: Triangular or cone-shaped enhancement with apex at nipple; suggests duct system and its branches (i.e., lobe or segment of breast)
Distinguish from focus: Tiny dot of enhancement (≤ 4 mm) too small to characterize shape or margins
Internal enhancement patterns of NME: Homogeneous or heterogeneous, clumped, clustered ring
Heterogeneous may have interspersed fat or normal glandular tissue
Clumped: Cobblestone, resembles bunch of grapes
Clustered ring: Thin rings of enhancement centered around ducts; enhancement in periductal stroma
Background parenchymal enhancement (BPE): Normal parenchymal enhancement can be misinterpreted as NME when presenting as large focal areas, multiple enhancing foci, or asymmetric enhancement
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
Chikarmane SA et al: Revisiting nonmass enhancement in breast MRI: analysis of outcomes and follow-up using the updated BI-RADS Atlas. AJR Am J Roentgenol. 209(5):1178-1184, 2017
Song SE et al: Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI. Eur Radiol. 27(12):5196-203, 2017
Milosevic ZC et al: Breast dynamic contrast enhanced MRI: Fibrocystic changes presenting as a non-mass enhancement mimicking malignancy. Radiol Oncol. 51(2):130-136, 2017
Chadashvili T et al: Nonmass enhancement on breast MRI: review of patterns with radiologic-pathologic correlation and discussion of management. AJR Am J Roentgenol. 204(1):219-27, 2015
Grimm LJ et al: Frequency of malignancy and imaging characteristics of probably benign lesions seen at breast MRI. AJR Am J Roentgenol. 205(2):442-7, 2015
Hollowell L et al: Lesion morphology on breast MRI affects targeted ultrasound correlation rate. Eur Radiol. 25(5):1279-84, 2015
Hsu HH et al. Breast nonmass enhancement detected with MRI: Uility and lesion characterization with second-look ultrasonography. Breast J. 21(6):579-87, 2015
Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
Giess CS et al: Patterns of nonmasslike enhancement at screening breast MR imaging of high-risk premenopausal women. Radiographics. 33(5):1343-60, 2013
Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
Uematsu T et al: High-spatial-resolution 3-T breast MRI of nonmasslike enhancement lesions: an analysis of their features as significant predictors of malignancy. AJR Am J Roentgenol. 198(5):1223-30, 2012
Baltzer PA et al: Nonmass lesions in magnetic resonance imaging of the breast: additional T2-weighted images improve diagnostic accuracy. J Comput Assist Tomogr. 35(3):361-6, 2011
Demartini WB et al: Probability of malignancy for lesions detected on breast MRI: a predictive model incorporating BI-RADS imaging features and patient characteristics. Eur Radiol. 21(8):1609-17, 2011
Jansen SA et al: The diverse pathology and kinetics of mass, nonmass, and focus enhancement on MR imaging of the breast. J Magn Reson Imaging. 33(6):1382-9, 2011
Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196:956-70; 2011
Abe H et al: MR-directed ("Second-look") ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol. 194:370-7; 2010
Baltzer PA et al: False-positive findings at contrast-enhanced breast MRI: a BI-RADS descriptor study. AJR Am J Roentgenol. 194(6):1658-63, 2010
DeMartini WB et al: Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol. 192(4):1128-34, 2009
Gutierrez RL et al: BI-RADS lesion characteristics predict likelihood of malignancy in breast MRI for masses but not for nonmasslike enhancement. AJR Am J Roentgenol. 193:994-1000; 2009
Gutierrez RL et al: Clinical indication and patient age predict likelihood of malignancy in suspicious breast MRI lesions. Acad Radiol. 16(10):1281-5, 2009
Meissnitzer M et al: Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 193:1025-9; 2009
Rosen EL, et al: BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J. 13:545-50, 2007.
Macura KJ et al: Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 26(6):1719-34; quiz 1719, 2006
Schnall MD et al. Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238:42-53; 2006
Liberman L et al: Breast lesions detected on MR imaging: Features and positive predictive value. AJR 179:171-178, 2002
Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology 219:484-94, 2001
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: 137-144; 1997
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
Nonmass enhancement (NME): MR enhancement distinct from parenchyma but not in mass or focus
Distribution types of NME: Focal area, regional, diffuse, linear, and segmental
Focal area: NME in confined area of breast; 5 mm up to < 25% of volume of quadrant
Regional: NME occupying large portion of breast tissue; ≥ 25% of 1 quadrant to > 1 quadrant; geographic
May show interspersed normal tissue; single or multiple regions of NME can be seen
Multiple regions: Enhancement in at least 2 large volumes of breast tissue separated by normal tissue; geographic and patchy
Diffuse: Enhancement throughout breast
Distinguish from linear and segmental distribution types
Linear: Enhancement in line that branches, suggests duct
Segmental: Triangular or cone-shaped enhancement with apex at nipple; suggests duct system and its branches (i.e., lobe or segment of breast)
Distinguish from focus: Tiny dot of enhancement (≤ 4 mm) too small to characterize shape or margins
Internal enhancement patterns of NME: Homogeneous or heterogeneous, clumped, clustered ring
Heterogeneous may have interspersed fat or normal glandular tissue
Clumped: Cobblestone, resembles bunch of grapes
Clustered ring: Thin rings of enhancement centered around ducts; enhancement in periductal stroma
Background parenchymal enhancement (BPE): Normal parenchymal enhancement can be misinterpreted as NME when presenting as large focal areas, multiple enhancing foci, or asymmetric enhancement
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
Chikarmane SA et al: Revisiting nonmass enhancement in breast MRI: analysis of outcomes and follow-up using the updated BI-RADS Atlas. AJR Am J Roentgenol. 209(5):1178-1184, 2017
Song SE et al: Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI. Eur Radiol. 27(12):5196-203, 2017
Milosevic ZC et al: Breast dynamic contrast enhanced MRI: Fibrocystic changes presenting as a non-mass enhancement mimicking malignancy. Radiol Oncol. 51(2):130-136, 2017
Chadashvili T et al: Nonmass enhancement on breast MRI: review of patterns with radiologic-pathologic correlation and discussion of management. AJR Am J Roentgenol. 204(1):219-27, 2015
Grimm LJ et al: Frequency of malignancy and imaging characteristics of probably benign lesions seen at breast MRI. AJR Am J Roentgenol. 205(2):442-7, 2015
Hollowell L et al: Lesion morphology on breast MRI affects targeted ultrasound correlation rate. Eur Radiol. 25(5):1279-84, 2015
Hsu HH et al. Breast nonmass enhancement detected with MRI: Uility and lesion characterization with second-look ultrasonography. Breast J. 21(6):579-87, 2015
Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
Giess CS et al: Patterns of nonmasslike enhancement at screening breast MR imaging of high-risk premenopausal women. Radiographics. 33(5):1343-60, 2013
Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
Uematsu T et al: High-spatial-resolution 3-T breast MRI of nonmasslike enhancement lesions: an analysis of their features as significant predictors of malignancy. AJR Am J Roentgenol. 198(5):1223-30, 2012
Baltzer PA et al: Nonmass lesions in magnetic resonance imaging of the breast: additional T2-weighted images improve diagnostic accuracy. J Comput Assist Tomogr. 35(3):361-6, 2011
Demartini WB et al: Probability of malignancy for lesions detected on breast MRI: a predictive model incorporating BI-RADS imaging features and patient characteristics. Eur Radiol. 21(8):1609-17, 2011
Jansen SA et al: The diverse pathology and kinetics of mass, nonmass, and focus enhancement on MR imaging of the breast. J Magn Reson Imaging. 33(6):1382-9, 2011
Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196:956-70; 2011
Abe H et al: MR-directed ("Second-look") ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol. 194:370-7; 2010
Baltzer PA et al: False-positive findings at contrast-enhanced breast MRI: a BI-RADS descriptor study. AJR Am J Roentgenol. 194(6):1658-63, 2010
DeMartini WB et al: Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol. 192(4):1128-34, 2009
Gutierrez RL et al: BI-RADS lesion characteristics predict likelihood of malignancy in breast MRI for masses but not for nonmasslike enhancement. AJR Am J Roentgenol. 193:994-1000; 2009
Gutierrez RL et al: Clinical indication and patient age predict likelihood of malignancy in suspicious breast MRI lesions. Acad Radiol. 16(10):1281-5, 2009
Meissnitzer M et al: Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 193:1025-9; 2009
Rosen EL, et al: BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J. 13:545-50, 2007.
Macura KJ et al: Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 26(6):1719-34; quiz 1719, 2006
Schnall MD et al. Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238:42-53; 2006
Liberman L et al: Breast lesions detected on MR imaging: Features and positive predictive value. AJR 179:171-178, 2002
Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology 219:484-94, 2001
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: 137-144; 1997
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