Images

Doctor's Information

Name : Maryam
Family : Noori
Affiliation :Teb Azma Imaging Center,Ghom,Iran
Academic Degree : Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------

Case Section

Breast Imaging

Patient's Information

Gender : Female
Age : 55

Clinical Summary

She had past history of left partial mastectomy from 14 years ago & right 3 years ago.

Imaging Findings

Mammogram identifies skin retraction, focal distortion & spiculated density at right UOQ (lumpectomy site), also coarse calcification & no suspicious mass or distortion in left breast. Because of the mentioned findings of right breast she candidates for MR-mammography; On T1w: ill defined hypointense area with skin retraction at right UOQ contains an area with fat signal intensity that suppressed on T2 fat sat images & shows no enhancement which is consistent with fat necrosis, but note is made of the large right anterior mediastinal mass, rib destruction, dilated internal mammary vessel & multiple pulmonary nodules.

Differential Diagnosis

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Final Diagnosis

metastatic breast carcinoma.

Discussion (Related Text)

Differentiation between a postoperative scar and a malignant tumor is an important application of MR mammography since the administration of contrast material yields a visual representation of the vascular conditions in the breast. Once the healing of a wound is completed, the differentiation between non-vascularized scar tissue and strongly vascularized tumor is therefore very reliable. The main differential diagnosis of such localized enhancing areas is a localized inflammatory process within the scar tissue. The reactive hyperemia causes can imitate the findings of a malignant tumor in MRI. The absence of contrast enhancement rules out an invasive tumor process with high reliability. The required interval between open biopsy and MR mammography is six months. MR mammography is indicated when x-ray mammography and ultrasonography cannot reliably differentiate between a postoperative scar and carcinoma. There are no defined recommendations for MRI follow-up intervals. Especially for patients with dense parenchyma limiting the sensitivity of x-ray mammography (ACR types 3 and 4). MR mammography seems advisable in the second or third year after lumpectomy and at intervals of, say, two years thereafter.

References

Practical MR Mammography, Uwe Fischer.

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