Dorothee
Barbara Engel1, Winifred Dunbar2, Fred Kelcz2
1Clinical Radiology and Nuclear
Medicine, University Medical Center Mannheim, Mannheim, Germany; 2Radiology,
School of Medicine and Public Health, Madison, WI, United States
Dynamic
contrast-enhanced (DCE) breast MRI has become the mainstay for assessing
breast problems not resolved by mammography and ultrasound. A signal intensity vs. time curve showing
rapid gadolinium contrast uptake and delayed washout is typically associated
with malignancy, but our study of 81 malignant spanning a wide size range
showed that the typical pattern was only in lesions > 1 cm. A delayed persistent pattern may be seen in
up to 20% of sub-centimeter lesions.
Radiologists should be aware of these exceptions and emphasize
morphology over contrast enhancement for small lesions.