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Segmental Enhancement (MR)
Katie M. Davis, DO; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Nonmass enhancement (NME): Neither focus nor mass
              • Segmental: Describes NME distribution
                • Triangular region or cone of NME, with apex pointing to nipple, suggesting duct and its branches
                • Suspicious for malignancy
              • Internal enhancement pattern of NME should also be described
                • Homogeneous: Confluent, uniform
                • Heterogeneous: Nonuniform, random, interspersed normal fibroglandular tissue and fat
                • Clumped: Cobblestone, various shapes and sizes, suspicious
                • Clustered ring: Thin rings of enhancement in periductal stroma, suspicious

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Imaging Recommendations

                      • Nuclear Medicine Findings

                        • Image-Guided Biopsy

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. 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):200-8, 2018
                                        2. Net JM et al: Relationships between human-extracted MRI tumor phenotypes of breast cancer and clinical prognostic indicators including receptor status and molecular subtype. Curr Probl Diagn Radiol. ePub, 2018
                                        3. Santiago L et al: MR imaging-guided breast interventions: indications, key principles, and imaging-pathology correlation. Magn Reson Imaging Clin N Am. 26(2):235-46, 2018
                                        4. Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-9, 2018
                                        5. Woodard GA et al: Qualitative radiogenomics: association between oncotype DX test recurrence score and BI-RADS mammographic and breast MR imaging features. Radiology. 286(1):60-70, 2018
                                        6. 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):1178-84, 2017
                                        7. Huang ML et al: Imaging-concordant benign MRI-guided vacuum-assisted breast biopsy may not warrant MRI follow-up. AJR Am J Roentgenol. 208(4):916-22, 2017
                                        8. Maglione KD et al: Radiologic-pathologic correlation for benign results after MRI-guided breast biopsy. AJR Am J Roentgenol. 209(2):442-53, 2017
                                        9. Navarro Vilar L et al: MR imaging findings in molecular subtypes of breast cancer according to BIRADS system. Breast J. 23(4):421-8, 2017
                                        10. Taşkın F et al: Lesion characteristics, histopathologic results, and follow-up of breast lesions after MRI-guided biopsy. Diagn Interv Radiol. 23(5):333-8, 2017
                                        11. Dratwa C et al: Breast MR biopsy: pathological and radiological correlation. Eur Radiol. 26(8):2510-9, 2016
                                        12. Raj SD et al: Stereotactic biopsy of segmental breast calcifications: is sampling of anterior and posterior components necessary? Acad Radiol. 23(6):682-6, 2016
                                        13. Shimauchi A et al: Morphology evaluation of nonmass enhancement on breast MRI: effect of a three-step interpretation model for readers' performances and biopsy recommendations. Eur J Radiol. 85(2):480-8, 2016
                                        14. 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
                                        15. Hsu HH et al: Breast nonmass enhancement detected with MRI: utility and lesion characterization with second-look ultrasonography. Breast J. 21(6):579-87, 2015
                                        16. Greenwood HI et al: Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 33(6):1569-88, 2013
                                        17. Tozaki M. BI-RADS-MRI terminology and evaluation of intraductal carcinoma and ductal carcinoma in situ. Breast Cancer. 20:13-20, 2013
                                        18. Morris EA, Comstock CE, Lee CH, et al. ACR BI-RADS magnetic resonance imaging. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology, 2013
                                        19. 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
                                        20. 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
                                        21. Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
                                        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. Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30:1673-87, 2010
                                        24. Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
                                        25. 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
                                        26. 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(4):1025-9, 2009
                                        27. Sakamoto N et al: Categorization of non-mass-like breast lesions detected by MRI. Breast Cancer. 15(3):241-6, 2008
                                        28. Yuen S et al: Segmental enhancement on breast MR images: differential diagnosis and diagnostic strategy. Eur Radiol.
                                        29. Tozaki M et al: High-spatial-resolution MRI of non-masslike breast lesions: interpretation model based on BI-RADS MRI descriptors. AJR Am J Roentgenol. 187(2):330-7, 2006
                                        30. Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
                                        31. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
                                        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

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Nonmass enhancement (NME): Neither focus nor mass
                                                    • Segmental: Describes NME distribution
                                                      • Triangular region or cone of NME, with apex pointing to nipple, suggesting duct and its branches
                                                      • Suspicious for malignancy
                                                    • Internal enhancement pattern of NME should also be described
                                                      • Homogeneous: Confluent, uniform
                                                      • Heterogeneous: Nonuniform, random, interspersed normal fibroglandular tissue and fat
                                                      • Clumped: Cobblestone, various shapes and sizes, suspicious
                                                      • Clustered ring: Thin rings of enhancement in periductal stroma, suspicious

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            • Nuclear Medicine Findings

                                                              • Image-Guided Biopsy

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. 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):200-8, 2018
                                                                              2. Net JM et al: Relationships between human-extracted MRI tumor phenotypes of breast cancer and clinical prognostic indicators including receptor status and molecular subtype. Curr Probl Diagn Radiol. ePub, 2018
                                                                              3. Santiago L et al: MR imaging-guided breast interventions: indications, key principles, and imaging-pathology correlation. Magn Reson Imaging Clin N Am. 26(2):235-46, 2018
                                                                              4. Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-9, 2018
                                                                              5. Woodard GA et al: Qualitative radiogenomics: association between oncotype DX test recurrence score and BI-RADS mammographic and breast MR imaging features. Radiology. 286(1):60-70, 2018
                                                                              6. 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):1178-84, 2017
                                                                              7. Huang ML et al: Imaging-concordant benign MRI-guided vacuum-assisted breast biopsy may not warrant MRI follow-up. AJR Am J Roentgenol. 208(4):916-22, 2017
                                                                              8. Maglione KD et al: Radiologic-pathologic correlation for benign results after MRI-guided breast biopsy. AJR Am J Roentgenol. 209(2):442-53, 2017
                                                                              9. Navarro Vilar L et al: MR imaging findings in molecular subtypes of breast cancer according to BIRADS system. Breast J. 23(4):421-8, 2017
                                                                              10. Taşkın F et al: Lesion characteristics, histopathologic results, and follow-up of breast lesions after MRI-guided biopsy. Diagn Interv Radiol. 23(5):333-8, 2017
                                                                              11. Dratwa C et al: Breast MR biopsy: pathological and radiological correlation. Eur Radiol. 26(8):2510-9, 2016
                                                                              12. Raj SD et al: Stereotactic biopsy of segmental breast calcifications: is sampling of anterior and posterior components necessary? Acad Radiol. 23(6):682-6, 2016
                                                                              13. Shimauchi A et al: Morphology evaluation of nonmass enhancement on breast MRI: effect of a three-step interpretation model for readers' performances and biopsy recommendations. Eur J Radiol. 85(2):480-8, 2016
                                                                              14. 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
                                                                              15. Hsu HH et al: Breast nonmass enhancement detected with MRI: utility and lesion characterization with second-look ultrasonography. Breast J. 21(6):579-87, 2015
                                                                              16. Greenwood HI et al: Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 33(6):1569-88, 2013
                                                                              17. Tozaki M. BI-RADS-MRI terminology and evaluation of intraductal carcinoma and ductal carcinoma in situ. Breast Cancer. 20:13-20, 2013
                                                                              18. Morris EA, Comstock CE, Lee CH, et al. ACR BI-RADS magnetic resonance imaging. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology, 2013
                                                                              19. 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
                                                                              20. 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
                                                                              21. Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
                                                                              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. Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30:1673-87, 2010
                                                                              24. Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
                                                                              25. 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
                                                                              26. 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(4):1025-9, 2009
                                                                              27. Sakamoto N et al: Categorization of non-mass-like breast lesions detected by MRI. Breast Cancer. 15(3):241-6, 2008
                                                                              28. Yuen S et al: Segmental enhancement on breast MR images: differential diagnosis and diagnostic strategy. Eur Radiol.
                                                                              29. Tozaki M et al: High-spatial-resolution MRI of non-masslike breast lesions: interpretation model based on BI-RADS MRI descriptors. AJR Am J Roentgenol. 187(2):330-7, 2006
                                                                              30. Morakkabati-Spitz N et al: Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol. 15(9):2010-7, 2005
                                                                              31. Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002