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.