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
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
Panigrahi B et al: Characteristics and outcomes of BI-RADS 3 lesions on breast MRI. Clin Breast Cancer. 19(1):e152-e159, 2019
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
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
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
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
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
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
Sung JS et al: Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat. ePub, 2018
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
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
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
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
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
Strigel RM et al: Screening Breast MRI Outcomes in Routine Clinical Practice: Comparison to BI-RADS Benchmarks. Acad Radiol. 24(4):411-417, 2017
Sutton EJ et al: Breast MRI radiomics: comparison of computer- and human-extracted imaging phenotypes. Eur Radiol Exp. 1(1):22, 2017
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
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
Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
Raza S et al: Small masses on breast MR: is biopsy necessary? Acad Radiol. 19(4):412-9, 2012
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
Eby PR et al: Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 193(3):861-7, 2009
Eby PR et al: Cancer yield of probably benign breast MR examinations. J Magn Reson Imaging. 26(4):950-5, 2007
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
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(1):42-53, 2006
Malich A et al: Potential MRI interpretation model: differentiation of benign from malignant breast masses. AJR Am J Roentgenol. 185(4):964-70, 2005
Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
Liberman L et al: Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 98(2):377-88, 2003
Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
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
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
Panigrahi B et al: Characteristics and outcomes of BI-RADS 3 lesions on breast MRI. Clin Breast Cancer. 19(1):e152-e159, 2019
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
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
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
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
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
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
Sung JS et al: Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat. ePub, 2018
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
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
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
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
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
Strigel RM et al: Screening Breast MRI Outcomes in Routine Clinical Practice: Comparison to BI-RADS Benchmarks. Acad Radiol. 24(4):411-417, 2017
Sutton EJ et al: Breast MRI radiomics: comparison of computer- and human-extracted imaging phenotypes. Eur Radiol Exp. 1(1):22, 2017
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
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
Morris EA et al: Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
Mahoney MC et al: Positive predictive value of BI-RADS MR imaging. Radiology. 264(1):51-8, 2012
Raza S et al: Small masses on breast MR: is biopsy necessary? Acad Radiol. 19(4):412-9, 2012
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
Eby PR et al: Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol. 193(3):861-7, 2009
Eby PR et al: Cancer yield of probably benign breast MR examinations. J Magn Reson Imaging. 26(4):950-5, 2007
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
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(1):42-53, 2006
Malich A et al: Potential MRI interpretation model: differentiation of benign from malignant breast masses. AJR Am J Roentgenol. 185(4):964-70, 2005
Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
Liberman L et al: Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol. 181(2):519-25, 2003
Liberman L et al: Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer. 98(2):377-88, 2003
Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001
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