Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes

Abstract

While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.

MRI-Visualized T2 Hyperintense Breast Lesions: Identifying Clinical and Imaging Factors Linked to Malignant Biopsy Outcomes

“…The differential diagnosis for lesions detected at breast MRI is based on the morphology of the lesion, perfusion kinetics, and inherent signal characteristics on T1 and T2 weighted sequences following the Breast Imaging Reporting and Data System (BI-RADS) lexicon 2 . Although breast carcinomas typically have short T2 relaxation times and are, therefore, low signal intensity on T2-weighted images, there are certain breast lesions, both benign and malignant, that may show signal intensity higher than that of the surrounding normal breast tissue, characterized as T2 hyperintense lesions [3][4][5][6][7] .…”

Relaxation–Diffusion T2–ADC Correlations in Breast Cancer Patients: A Spatiotemporally Encoded 3T MRI Assessment

“…An increase in macromolecular density should also affect the transverse relaxation time, T2, of the water [7]. T2-weighted images do indeed play a role in the breast cancer MRI analysis, by providing an anatomical reference [8], improving the delineation of non-mass ductal carcinoma in situ (DCIS) lesions [9], and omitting unnecessary biopsies when identifying benign, bright lesions in T2-weighted scans [10][11][12]. However, beyond serving as an adjunct tool to better characterize the breast anatomy, the use of quantitative T2 values is uncommon in the clinical settings-even if its potential benefits for breast imaging have often been discussed [13][14][15].…”