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MR BI-RADS Lexicon and Usage
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Breast Imaging Reporting and Data System (BI-RADS) for Magnetic Resonance (MR) Imaging
            • Terms may undergo revision; consult current edition of lexicon: American College of Radiology (ACR)
            • Minor modifications to phrasing have been made
        • Definitions

          • Standardized terminology developed through ACR
            • Lexicon to describe background enhancement, findings, associated findings, kinetics, assessment, and management recommendations
          • Maximum-intensity pixel (MIP) projections: From 3D postcontrast subtraction data set, 3D reconstruction of brightest pixels (essentially MR angiogram)
          • Computer-aided detection (CAD) parametric mapping
            • Typically, thresholding based on % enhancement in first 2 minutes, usually > 50% or > 100% over background; then color-coding by delayed kinetic behavior (persistent, plateau, washout)
          • Kinetics: Plot of signal intensity (SI) of lesion over time, following intravenous contrast
            • Persistent kinetics = blue
            • Plateau kinetics = yellow (historic software was sometimes green)
            • Washout kinetics = red
          • Region of interest (ROI); should be at least 3 pixels
          • Nonmass enhancement (NME): Area, not mass, with internal enhancement resulting in pattern discrete from surrounding parenchyma
            • Usually has interspersed fat or normal tissue
          • Abbreviated MR = Pre- and single postcontrast T1 volume acquisition with subtraction, MIP
            • May include T2WI/STIR; does not include kinetic information

        IMAGING

        • General Features

          PATHOLOGY

          • Pathology-Based Imaging Issues

            DIAGNOSTIC CHECKLIST

            • Assessments and Recommendations

              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. Panigrahi B et al: Characteristics and outcomes of BI-RADS 3 lesions on breast MRI. Clin Breast Cancer. 19(1):e152-e159, 2019
              3. Asada T et al: Grading system to categorize breast MRI using BI-RADS 5th edition: a statistical study of non-mass enhancement descriptors in terms of probability of malignancy. Jpn J Radiol. 36(3):200-208, 2018
              4. Fujiwara K et al: Grading system to categorize breast MRI in BI-RADS 5th Edition: a multivariate study of breast mass descriptors in terms of probability of malignancy. AJR Am J Roentgenol. 210(3):W118-W127, 2018
              5. Lee SM et al: Patterns of malignant non-mass enhancement on 3-T breast MRI help predict invasiveness: using the BI-RADS lexicon fifth edition. Acta Radiol. 59(11):1292-1299, 2018
              6. Marino MA et al: Imaging phenotypes in women at high risk for breast cancer on mammography, ultrasound, and magnetic resonance imaging using the fifth edition of the Breast Imaging Reporting and Data System. Eur J Radiol. 106:150-159, 2018
              7. Martaindale SR: Breast MR imaging: atlas of anatomy, physiology, pathophysiology, and Breast Imaging Reporting and Data Systems lexicon. Magn Reson Imaging Clin N Am. 26(2):179-190, 2018
              8. Montemezzi S et al: Is there a correlation between 3T multiparametric MRI and molecular subtypes of breast cancer? Eur J Radiol. 108:120-127, 2018
              9. Sung JS et al: Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat. ePub, 2018
              10. 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
              11. Chikarmane SA et al: Prevalence and Predictive Value of BI-RADS 3, 4, and 5 Lesions Detected on Breast MRI: Correlation with Study Indication. Acad Radiol. 24(4):435-441, 2017
              12. Giess CS et al: Clinical Utility of Breast MRI in the Diagnosis of Malignancy After Inconclusive or Equivocal Mammographic Diagnostic Evaluation. AJR Am J Roentgenol. 208(6):1378-1385, 2017
              13. Shin K et al: Interpretation of Breast MRI Utilizing the BI-RADS Fifth Edition Lexicon: How Are We Doing and Where Are We Headed? Curr Probl Diagn Radiol. 46(1):26-34, 2017
              14. Strigel RM et al: Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI. AJR Am J Roentgenol. 208(6):1392-1399, 2017
              15. Strigel RM et al: Screening Breast MRI Outcomes in Routine Clinical Practice: Comparison to BI-RADS Benchmarks. Acad Radiol. 24(4):411-417, 2017
              16. Sutton EJ et al: Breast MRI radiomics: comparison of computer- and human-extracted imaging phenotypes. Eur Radiol Exp. 1(1):22, 2017
              17. Chikarmane SA et al: Characteristics, Malignancy Rate, and Follow-up of BI-RADS Category 3 Lesions Identified at Breast MR Imaging: Implications for MR Image Interpretation and Management. Radiology. 280(3):707-15, 2016
              18. Machida Y et al: Two distinct types of linear distribution in nonmass enhancement at breast MR imaging: difference in positive predictive value between linear and branching patterns. Radiology. 276(3):686-94, 2015
              19. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
              20. Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
              21. Raza S et al: Small masses on breast MR: is biopsy necessary? Acad Radiol. 19(4):412-9, 2012
              22. Sohns C et al: Value of the BI-RADS classification in MR-Mammography for diagnosis of benign and malignant breast tumors. Eur Radiol. 21(12):2475-83, 2011
              23. Eby PR et al: Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 193(3):861-7, 2009
              24. Eby PR et al: Cancer yield of probably benign breast MR examinations. J Magn Reson Imaging. 26(4):950-5, 2007
              25. 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
              26. Macura KJ et al: Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 26(6):1719-34; quiz 1719, 2006
              27. Schnall MD et al: Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238(1):42-53, 2006
              28. Malich A et al: Potential MRI interpretation model: differentiation of benign from malignant breast masses. AJR Am J Roentgenol. 185(4):964-70, 2005
              29. Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
              30. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
              31. Liberman L et al: Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 98(2):377-88, 2003
              32. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
              33. Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001
              Related Anatomy
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              References
              Tables

              Tables

              KEY FACTS

              • Terminology

                • Imaging

                  • Diagnostic Checklist

                    TERMINOLOGY

                    • Abbreviations

                      • Breast Imaging Reporting and Data System (BI-RADS) for Magnetic Resonance (MR) Imaging
                        • Terms may undergo revision; consult current edition of lexicon: American College of Radiology (ACR)
                        • Minor modifications to phrasing have been made
                    • Definitions

                      • Standardized terminology developed through ACR
                        • Lexicon to describe background enhancement, findings, associated findings, kinetics, assessment, and management recommendations
                      • Maximum-intensity pixel (MIP) projections: From 3D postcontrast subtraction data set, 3D reconstruction of brightest pixels (essentially MR angiogram)
                      • Computer-aided detection (CAD) parametric mapping
                        • Typically, thresholding based on % enhancement in first 2 minutes, usually > 50% or > 100% over background; then color-coding by delayed kinetic behavior (persistent, plateau, washout)
                      • Kinetics: Plot of signal intensity (SI) of lesion over time, following intravenous contrast
                        • Persistent kinetics = blue
                        • Plateau kinetics = yellow (historic software was sometimes green)
                        • Washout kinetics = red
                      • Region of interest (ROI); should be at least 3 pixels
                      • Nonmass enhancement (NME): Area, not mass, with internal enhancement resulting in pattern discrete from surrounding parenchyma
                        • Usually has interspersed fat or normal tissue
                      • Abbreviated MR = Pre- and single postcontrast T1 volume acquisition with subtraction, MIP
                        • May include T2WI/STIR; does not include kinetic information

                    IMAGING

                    • General Features

                      PATHOLOGY

                      • Pathology-Based Imaging Issues

                        DIAGNOSTIC CHECKLIST

                        • Assessments and Recommendations

                          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. Panigrahi B et al: Characteristics and outcomes of BI-RADS 3 lesions on breast MRI. Clin Breast Cancer. 19(1):e152-e159, 2019
                          3. Asada T et al: Grading system to categorize breast MRI using BI-RADS 5th edition: a statistical study of non-mass enhancement descriptors in terms of probability of malignancy. Jpn J Radiol. 36(3):200-208, 2018
                          4. Fujiwara K et al: Grading system to categorize breast MRI in BI-RADS 5th Edition: a multivariate study of breast mass descriptors in terms of probability of malignancy. AJR Am J Roentgenol. 210(3):W118-W127, 2018
                          5. Lee SM et al: Patterns of malignant non-mass enhancement on 3-T breast MRI help predict invasiveness: using the BI-RADS lexicon fifth edition. Acta Radiol. 59(11):1292-1299, 2018
                          6. Marino MA et al: Imaging phenotypes in women at high risk for breast cancer on mammography, ultrasound, and magnetic resonance imaging using the fifth edition of the Breast Imaging Reporting and Data System. Eur J Radiol. 106:150-159, 2018
                          7. Martaindale SR: Breast MR imaging: atlas of anatomy, physiology, pathophysiology, and Breast Imaging Reporting and Data Systems lexicon. Magn Reson Imaging Clin N Am. 26(2):179-190, 2018
                          8. Montemezzi S et al: Is there a correlation between 3T multiparametric MRI and molecular subtypes of breast cancer? Eur J Radiol. 108:120-127, 2018
                          9. Sung JS et al: Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat. ePub, 2018
                          10. 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
                          11. Chikarmane SA et al: Prevalence and Predictive Value of BI-RADS 3, 4, and 5 Lesions Detected on Breast MRI: Correlation with Study Indication. Acad Radiol. 24(4):435-441, 2017
                          12. Giess CS et al: Clinical Utility of Breast MRI in the Diagnosis of Malignancy After Inconclusive or Equivocal Mammographic Diagnostic Evaluation. AJR Am J Roentgenol. 208(6):1378-1385, 2017
                          13. Shin K et al: Interpretation of Breast MRI Utilizing the BI-RADS Fifth Edition Lexicon: How Are We Doing and Where Are We Headed? Curr Probl Diagn Radiol. 46(1):26-34, 2017
                          14. Strigel RM et al: Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI. AJR Am J Roentgenol. 208(6):1392-1399, 2017
                          15. Strigel RM et al: Screening Breast MRI Outcomes in Routine Clinical Practice: Comparison to BI-RADS Benchmarks. Acad Radiol. 24(4):411-417, 2017
                          16. Sutton EJ et al: Breast MRI radiomics: comparison of computer- and human-extracted imaging phenotypes. Eur Radiol Exp. 1(1):22, 2017
                          17. Chikarmane SA et al: Characteristics, Malignancy Rate, and Follow-up of BI-RADS Category 3 Lesions Identified at Breast MR Imaging: Implications for MR Image Interpretation and Management. Radiology. 280(3):707-15, 2016
                          18. Machida Y et al: Two distinct types of linear distribution in nonmass enhancement at breast MR imaging: difference in positive predictive value between linear and branching patterns. Radiology. 276(3):686-94, 2015
                          19. Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                          20. Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
                          21. Raza S et al: Small masses on breast MR: is biopsy necessary? Acad Radiol. 19(4):412-9, 2012
                          22. Sohns C et al: Value of the BI-RADS classification in MR-Mammography for diagnosis of benign and malignant breast tumors. Eur Radiol. 21(12):2475-83, 2011
                          23. Eby PR et al: Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 193(3):861-7, 2009
                          24. Eby PR et al: Cancer yield of probably benign breast MR examinations. J Magn Reson Imaging. 26(4):950-5, 2007
                          25. 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
                          26. Macura KJ et al: Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 26(6):1719-34; quiz 1719, 2006
                          27. Schnall MD et al: Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238(1):42-53, 2006
                          28. Malich A et al: Potential MRI interpretation model: differentiation of benign from malignant breast masses. AJR Am J Roentgenol. 185(4):964-70, 2005
                          29. Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
                          30. Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
                          31. Liberman L et al: Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 98(2):377-88, 2003
                          32. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
                          33. Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001