A Rim-Enhanced Mass with Central Cystic Changes on MR Imaging: How to Distinguish Breast Cancer from Inflammatory Breast Diseases?

Abstract

ObjectiveTo evaluate the capacity of magnetic resonance imaging (MRI) to distinguish breast cancer from inflammatory breast diseases manifesting as a rim-enhanced mass with central cystic changes.Materials and MethodsForty cases of breast cancer and 52 of inflammatory breast diseases showing a rim-enhanced mass with central cystic changes were retrospectively reviewed. All cases underwent dynamic contrast-enhanced MRI and 31 of them underwent diffusion-weighted imaging (DWI). Morphological features, dynamic parameters and apparent diffusion coefficient (ADC) values were comparatively analyzed using univariate analysis and binary logistic regression analysis.ResultsBreast cancer had a significantly thicker wall than the inflammatory breast diseases (P<0.001) while internal enhancing septa were more common in inflammatory breast diseases (P = 0.003). On DWI, 86.7% of breast cancers demonstrate a peripheral hyperintensity whereas 93.8% of inflammatory breast diseases had a central hyperintensity (P<0.001). Compared to the inflammatory breast diseases, breast cancers had a lower ADC value for the wall (1.09×10−3 mm2/s vs 1.42×10−3 mm2/s, P<0.001) and a higher ADC value for the central part (1.94×10−3 mm2/s vs 1.05×10−3 mm2/s, P<0.001).ConclusionsBoth breast cancer and inflammatory breast diseases could present as a rim-enhanced mass with central cystic changes on MRI. Integrated analysis of the MR findings can allow for an accurate differential diagnosis.

Differentiation between Pure Mucinous Breast Carcinomas and Fibroadenomas with Strong High-Signal Intensity on T2-Weighted Images from Dynamic Contrast-Enhanced Magnetic Resonance Imaging

“…We speculate that local rim enhancement detected in PMBCs with heterogeneous enhancement probably results from higher tumor cellularity at the periphery than in the center of the local area of the tumor. Rim enhancement is generally suggestive of malignancy, which correlates with more numerous microvessels at the periphery than in the center of the tumor, or necrosis or fibrosis in the center [20][21][22]. In a few cases, rim enhancement is detected also in benign lesions such as abscesses, inflammatory cysts, galactoceles, fat necrosis, and FA [14,22,23].…”

“…Rim enhancement is generally suggestive of malignancy, which correlates with more numerous microvessels at the periphery than in the center of the tumor, or necrosis or fibrosis in the center [20][21][22]. In a few cases, rim enhancement is detected also in benign lesions such as abscesses, inflammatory cysts, galactoceles, fat necrosis, and FA [14,22,23]. It has been hypothesized that relative hypovascularity in the center of an FA with rim enhancement is due to the presence of fibrosis or hyalinization [14].…”

Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls

“…Signs and symptoms that strongly suggest IBC ing and breast edema with dilated lymphatics are more characteristic of IBC; heterogeneous parenchyma, axillary adenopathy, and irregular or conglomerate masses are less discriminatory. At MR imaging, extensive skin thickening with associated enhancement; breast enlargement; axillary adenopathy; increased breast signal intensity on T2-weighted images, which may extend to the chest wall; and a rapidly enhancing breast mass or abnormal parenchymal enhancement are more suggestive of IBC (53,54).…”

Dynamic properties of water in breast pathology depend on the histological compounds: distinguishing tissue malignancy by water diffusion coefficients

“…Nevertheless, in vitro diffusion studies are important because they provide biochemical and biophysical information that reflects the state of malignant tissues. By contrast, because in vivo diffusion studies average the ADC, they exclude information on the FDP and SDPs of water (diffusion coefficients and spin populations) [ 38 – 40 ].…”