Invasive Ductal Carcinoma (Moderately Differentiated)


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Clinical History:
A 44-year-old female presented with an abnormal right breast imaging by routine screening mammography. She then obtained a breast ultrasound, which showed a solid mass in the right breast measuring. A core needle biopsy was performed revealing intraductal adenocarcinoma. An MRI was the obtained to evaluate the extent of the disease.

Invasive Ductal Carcinoma (Moderately Differentiated).

MR Technique:
3.0 T Scanner (Siemens Verio) using a 15-channel breast coil. Image 1: axial T1 FLASH 3D scan (TR/TE 5.9/2.2 ms, scan time 1 min 17 sec, slice thickness 1.2 mm); Image 2: axial T1 FLASH 3D after administration of 0.1 mmol/kg of gadolinium chelate using a Dynamic Series (TR/TE 4.5/1.6, scan time 6 min 12 sec, slice thickness 1.0) performed by obtaining five time point acquisitions one minute apart and digitally subtracting the precontrast image; Image 3: Maximum Intensity Projection (MIP) scan (TR/TE 4.5/1.6, slice thickness 370 mm); Image 4: Kinetic Curve obtained from study to assess for any increase in signal intensity after contrast administration.

Imaging Findings:
Precontrast T1 weighted image shows a space occupying mass in the upper outer quadrant of the right breast.  After contrast administration, the highly spiculated irregular 2.5 cm mass enhances in a heterogeneous manner.  The rim enhances intensely.  Both rim enhancement and heterogenous enhancement are characteristics highly suggestive of malignancy.  The MIP demonstrates the full extent of the mass with at least 3 satellite nodules which were not appreciated on mammography or ultrasound, thus demonstrating that the full extent of the cancer is 4 cm.  Finally, the kinetic curve demonstrates fast wash in of contrast (>100% increase in enhancement in the first 2 minutes) and fast wash-out (i.e. Type III curve), also very characteristic of malignancy.