MR imaging allows detection of mammographically and clinically occult foci of carcinoma in patients with suspected breast cancer.

Diagnostic yield is higher in lytic than in sclerotic bone lesions, in larger lesions, and for longer specimens. Obtaining a minimum of three specimens in bone lesions and four specimens in soft-tissue lesions optimizes diagnostic yield.

The purpose of this study was to develop, standardize, and test reproducibility of a lexicon for reporting contrastenhanced breast magnetic resonance imaging (MRI) examinations. To standardize breast MRI lesion description and reporting, seven radiologists with extensive breast MRI experience developed consensus on technical detail, clinical history, and terminology reporting to describe kinetic and architectural features of lesions detected on contrastenhanced breast MR images. This lexicon adapted American College of Radiology Breast Imaging and Data Reporting System terminology for breast MRI reporting, including recommendations for reporting clinical history, technical parameters for breast MRI, descriptions for general breast composition, morphologic and kinetic characteristics of mass lesions or regions of abnormal enhancement, and overall impression and management recommendations. To test morphology reproducibility, seven radiologists assessed morphology characteristics of 85 contrast-enhanced breast MRI studies. Data from each independent reader were used to compute weighted and unweighted kappa () statistics for interobserver agreement among readers. The MR lexicon differentiates two lesion types, mass and non-mass-like enhancement based on morphology and geographical distribution, with descriptors of shape, margin, and internal enhancement. Index terms: breast; magnetic resonance; breast neoplasms; breast neoplasm diagnosis; observer performance; kappa THERE IS A WIDE VARIETY of breast magnetic resonance imaging (MRI) techniques, resulting in varying interpretation criteria for benign or malignant lesions. This results in a major problem in consolidating data from breast MRI studies. A second problem is lack of a standard language to report breast lesion architecture and/or kinetic data. Varying terms have been used to describe findings to distinguish between benign and malignant breast disease on high spatial resolution scans emphasizing lesion morphology (1-5), contrast enhancement studies that describe signal intensity variations over time (6 -8), and technologies that collect both high spatial and temporal resolution data (9).This lack of consensus in terminology impairs comparison of MR research data among studies, decreases the assessment of the applicability of any one MR technique, and impedes the scientific evaluation of the efficacy of MRI for breast cancer. Clearly, there is a need to reach consensus among experts in how to describe lesions found on breast MRI, to standardize MRI reporting, and to reconcile terms describing breast lesion morphology and enhancement. A standard language for breast MRI would unify the breast MR research field by

Soft-tissue lesions are frequently encountered by radiologists in everyday clinical practice. Characterization of these soft-tissue lesions remains problematic, despite advances in imaging. By systematically using clinical history, lesion location, mineralization on radiographs, and signal intensity characteristics on magnetic resonance images, one can (a) determine the diagnosis for the subset of determinate lesions that have characteristic clinical and imaging features and (b) narrow the differential diagnosis for lesions that demonstrate indeterminate characteristics. If a lesion cannot be characterized as a benign entity, the lesion should be reported as indeterminate, and the patient should undergo biopsy to exclude malignancy.

An interpretation model that incorporates breast MR architectural features can achieve high sensitivity and improve specificity for diagnosing breast cancer.

Calcific tendinitis is caused by the pathologic deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any joint can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on magnetic resonance imaging. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration and steroid injection of calcific tendinitis are useful techniques performed by the radiologist for the treatment of symptomatic cases. Familiarity with these procedures and their imaging appearance is an important aspect in the management of this common disease.

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An interpretation model for evaluating magnetic resonance (MR) images of the breast was constructed that allowed differentiation of benign from malignant palpable or mammographically visible abnormalities. Architectural features define each node of the model. Investigation was subsequently made of the histologic findings in individuals within each node and of the frequency with which each histologic finding manifested as a particular architectural feature to determine whether nodal location and specific histologic findings are mutually predictive. The strongest associations were found between fibrocystic change and smooth masses, fibroadenoma and lobulated masses with nonenhancing internal septations, invasive ductal carcinoma (with or without ductal carcinoma in situ [DCIS]) and enhancing irregular or spiculated masses, invasive tubular carcinoma or radial scar and spiculated masses, medullary or colloid carcinoma and enhancing lobulated masses, invasive lobular carcinoma and the absence of a focal mass, DCIS and ductal enhancement, and DCIS (with or without invasive ductal carcinoma) and regional enhancement. Nodal location and histologic findings proved to be mutually predictive within the model; that is, the nodal location of MR imaging features within the model can be used to predict histologic findings and vice versa.