title: Peripheral washout sign on contrast-enhanced MR images of the breast.
abstract: OBJECTIVE
  To assess the value of the peripheral washout sign on delayed contrast material-enhanced magnetic resonance (MR) images in differentiation of benign from malignant breast masses.
  
  
  METHODS
  In 49 women with 79 breast lesions (55 malignant and 24 benign), dynamic contrast-enhanced MR imaging was performed every 90 seconds during the first 7 minutes and repeated at 10, 20, 30, 40, 50, and 60 minutes after injection of contrast material. Qualitative analysis of the images was performed to evaluate the presence of the peripheral washout sign (a hypointense zone in the periphery of the lesion relative to the center). Quantitative analysis of the images was performed by measuring the signal intensity of the periphery and center of the lesions.
  
  
  RESULTS
  The peripheral washout sign was seen in 28 (51%) of the 55 carcinomas on delayed contrast-enhanced MR images (> 10 minutes). Quantitative analysis demonstrated different enhancement profiles of the periphery and center of these lesions. The periphery showed early increase and decrease of enhancement, while the center showed gradual increase and persistent enhancement. The peripheral washout sign was not seen in any of the benign lesions. Specificity was 100% and sensitivity was 51% for diagnosis of breast carcinoma.
  
  
  CONCLUSIONS
  Peripheral washout may be a reliable sign of malignancy on delayed contrast-enhanced MR images of the breast.
authors.affiliation: Department of Radiology, Rudolf Virchow Hospital, Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Sherif
authors.forename: A E
authors.initials: AE
authors.lastname: Mahfouz
authors.forename: H
authors.initials: H
authors.lastname: Oellinger
authors.forename: J
authors.initials: J
authors.lastname: Hadijuana
authors.forename: J U
authors.initials: JU
authors.lastname: Blohmer
authors.forename: M
authors.initials: M
authors.lastname: Taupitz
authors.forename: R
authors.initials: R
authors.lastname: Felix
authors.forename: B
authors.initials: B
authors.lastname: Hamm
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA