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Breast
Lesion Imaging Characteristics
MR Findings
Focus (MR)
Focus (MR)
Lauren Q. Chang Sen, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Punctate nonspecific enhancement
                • Early literature, no longer used: Incidental enhancing lesions (IELs), unidentified bright objects (UBOs)

              • Definitions

                • Tiny dot of contrast enhancement, ≤ 4 mm, too small to characterize morphologically
                  • Cannot characterize internal enhancement characteristics
                • Multiple, scattered, separated by normal tissue: Considered background parenchymal enhancement (BPE)
                  • Not confluent or grouped within small area
                  • Distinguish from focal area(s) clumped enhancement

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • MR Findings

                      • Imaging Recommendations

                        • Image-Guided Biopsy

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Spick C et al: Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis. Eur Radiol. 28(5):1919-28, 2018
                                            2. Gweon HM et al: Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients. Eur Radiol. 27(8):3211-3216, 2017
                                            3. Machida Y et al: Single focus on breast magnetic resonance imaging: diagnosis based on kinetic pattern and patient age. Acta Radiol. 58(6):652-659, 2017
                                            4. Uematsu T et al: Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone. Eur Radiol. 26(4):1064-72, 2016
                                            5. 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
                                            6. Ha R et al: Breast magnetic resonance imaging: management of an enhancing focus. Radiol Clin North Am. 52(3):585-9, 2014
                                            7. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                            8. Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
                                            9. Raza S et al: Small masses on breast MR: is biopsy necessary? Acad Radiol. 19(4):412-9, 2012
                                            10. Candelaria R et al: Second-look US examination of MR-detected breast lesions. J Clin Ultrasound. 39(3):115-21, 2011
                                            11. 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
                                            12. 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
                                            13. 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
                                            14. Dietzel M et al: Differential diagnosis of breast lesions 5 mm or less: is there a role for magnetic resonance imaging? J Comput Assist Tomogr. 34(3):456-64, 2010
                                            15. Obdeijn IM et al: Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition. Breast Cancer Res Treat. 119(2):399-407, 2010
                                            16. Weinstein SP et al: Frequency of malignancy seen in probably benign lesions at contrast-enhanced breast MR imaging: findings from ACRIN 6667. Radiology. 255(3):731-7, 2010
                                            17. 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
                                            18. Eby PR et al: Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 2009;193:861-7
                                            19. Chen JH et al: Fibrocystic change of the breast presenting as a focal lesion mimicking breast cancer in MR imaging. J Magn Reson Imaging. 28(6):1499-505, 2008
                                            20. Han BK et al: Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol. 191(6):1798-804, 2008
                                            21. Van den Bosch MA et al: Does size matter? Likelihood of cancer in MRI-detected lesions less than 5 mm. AJR Am J Roentgenol. 188(6):W571, 2007
                                            22. Liberman L et al: Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. AJR Am J Roentgenol. 186(2):426-30, 2006
                                            23. Yabuuchi H et al: Incidentally detected lesions on contrast-enhanced MR imaging in candidates for breast-conserving therapy: Correlation between MR findings and histological diagnosis. J Magn Reson Imaging. 23(4):486-92, 2006
                                            24. 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
                                            25. Sadowski EA et al: Frequency of malignancy in lesions classified as probably benign after dynamic contrast-enhanced breast MRI examination. J Magn Reson Imaging. 21(5):556-64, 2005
                                            26. Tozaki M et al: High-spatial-resolution MR imaging of focal breast masses: interpretation model based on kinetic and morphological parameters. Radiat Med. 23(1):43-50, 2005
                                            27. Liberman L et al: Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 98(2):377-88, 2003
                                            28. Teifke A et al: Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol. 181(3):655-62, 2003
                                            29. Heinig A et al: Suppression of unspecific enhancement on breast magnetic resonance imaging (MRI) by antiestrogen medication. Tumori. 88(3):215-23, 2002
                                            30. Yuh EL et al: Clinical outcomes of incidental enhancing lesions detected on contrast-enhanced breast MRI. Radiology. 225:325-6 (abstr), 2002
                                            31. Brown J et al: Incidental enhancing lesions found on MR imaging of the breast. AJR Am J Roentgenol. 176(5):1249-54, 2001
                                            32. 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
                                            33. Nunes LW et al: Breast MR imaging: interpretation model. Radiology. 202(3):833-41, 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

                                                        • Synonyms

                                                          • Punctate nonspecific enhancement
                                                          • Early literature, no longer used: Incidental enhancing lesions (IELs), unidentified bright objects (UBOs)

                                                        • Definitions

                                                          • Tiny dot of contrast enhancement, ≤ 4 mm, too small to characterize morphologically
                                                            • Cannot characterize internal enhancement characteristics
                                                          • Multiple, scattered, separated by normal tissue: Considered background parenchymal enhancement (BPE)
                                                            • Not confluent or grouped within small area
                                                            • Distinguish from focal area(s) clumped enhancement

                                                        IMAGING

                                                        • General Features

                                                          • Mammographic Findings

                                                            • Ultrasonographic Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  • Image-Guided Biopsy

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Spick C et al: Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis. Eur Radiol. 28(5):1919-28, 2018
                                                                                      2. Gweon HM et al: Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients. Eur Radiol. 27(8):3211-3216, 2017
                                                                                      3. Machida Y et al: Single focus on breast magnetic resonance imaging: diagnosis based on kinetic pattern and patient age. Acta Radiol. 58(6):652-659, 2017
                                                                                      4. Uematsu T et al: Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone. Eur Radiol. 26(4):1064-72, 2016
                                                                                      5. 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
                                                                                      6. Ha R et al: Breast magnetic resonance imaging: management of an enhancing focus. Radiol Clin North Am. 52(3):585-9, 2014
                                                                                      7. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                                                                      8. Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
                                                                                      9. Raza S et al: Small masses on breast MR: is biopsy necessary? Acad Radiol. 19(4):412-9, 2012
                                                                                      10. Candelaria R et al: Second-look US examination of MR-detected breast lesions. J Clin Ultrasound. 39(3):115-21, 2011
                                                                                      11. 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
                                                                                      12. 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
                                                                                      13. 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
                                                                                      14. Dietzel M et al: Differential diagnosis of breast lesions 5 mm or less: is there a role for magnetic resonance imaging? J Comput Assist Tomogr. 34(3):456-64, 2010
                                                                                      15. Obdeijn IM et al: Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition. Breast Cancer Res Treat. 119(2):399-407, 2010
                                                                                      16. Weinstein SP et al: Frequency of malignancy seen in probably benign lesions at contrast-enhanced breast MR imaging: findings from ACRIN 6667. Radiology. 255(3):731-7, 2010
                                                                                      17. 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
                                                                                      18. Eby PR et al: Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 2009;193:861-7
                                                                                      19. Chen JH et al: Fibrocystic change of the breast presenting as a focal lesion mimicking breast cancer in MR imaging. J Magn Reson Imaging. 28(6):1499-505, 2008
                                                                                      20. Han BK et al: Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol. 191(6):1798-804, 2008
                                                                                      21. Van den Bosch MA et al: Does size matter? Likelihood of cancer in MRI-detected lesions less than 5 mm. AJR Am J Roentgenol. 188(6):W571, 2007
                                                                                      22. Liberman L et al: Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. AJR Am J Roentgenol. 186(2):426-30, 2006
                                                                                      23. Yabuuchi H et al: Incidentally detected lesions on contrast-enhanced MR imaging in candidates for breast-conserving therapy: Correlation between MR findings and histological diagnosis. J Magn Reson Imaging. 23(4):486-92, 2006
                                                                                      24. 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
                                                                                      25. Sadowski EA et al: Frequency of malignancy in lesions classified as probably benign after dynamic contrast-enhanced breast MRI examination. J Magn Reson Imaging. 21(5):556-64, 2005
                                                                                      26. Tozaki M et al: High-spatial-resolution MR imaging of focal breast masses: interpretation model based on kinetic and morphological parameters. Radiat Med. 23(1):43-50, 2005
                                                                                      27. Liberman L et al: Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 98(2):377-88, 2003
                                                                                      28. Teifke A et al: Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol. 181(3):655-62, 2003
                                                                                      29. Heinig A et al: Suppression of unspecific enhancement on breast magnetic resonance imaging (MRI) by antiestrogen medication. Tumori. 88(3):215-23, 2002
                                                                                      30. Yuh EL et al: Clinical outcomes of incidental enhancing lesions detected on contrast-enhanced breast MRI. Radiology. 225:325-6 (abstr), 2002
                                                                                      31. Brown J et al: Incidental enhancing lesions found on MR imaging of the breast. AJR Am J Roentgenol. 176(5):1249-54, 2001
                                                                                      32. 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
                                                                                      33. Nunes LW et al: Breast MR imaging: interpretation model. Radiology. 202(3):833-41, 1997