title: Malignant spiculated breast masses: dynamic contrast enhanced MR (DCE-MR) imaging enhancement characteristics and histopathological correlation.
abstract: OBJECTIVE
  Spiculation of breast masses is usually the result of significant desmoplastic reaction. Diminished neovascularization is expected due to sparsely dispersed tumor cells within the lesion. This feature can cause differences in enhancement patterns which can cause pitfalls while evaluating MR images as well. Aim of this study is to explore the enhancement characteristics of malignant spiculated masses and to correlate these findings with histopathological features.
  
  
  METHODS
  Eighteen spiculated and seventeen non-spiculated masses depicted with mammography were included in the study. MR imaging was performed with 1.5 T magnet with breast coil. In MR imaging, T2-weighted turbo spin echo (TSE) with fat suppression sequence followed by pre- and post-contrast T1-weighted 3D-fast low angle shot (FLASH) sequences were used. Lesions were evaluated according to enhancement characteristics: early phase enhancement (first 2 min; less than 50%, 50-100% and more than 100%), late phase enhancement (2-6 min; persistent, plateau and washout) and inner enhancement pattern (homogenous, heterogenous and rim). Desmoplasia and lymphocyte infiltration was classified as mild, moderate and severe. MR images and histopathological findings (desmoplasia, lymphocyte infiltration and grade) of both groups were compared.
  
  
  RESULTS
  Mean ages of patients in spiculated and non-spiculated-mass groups were 55.07 (41-71) and 47.35 (31-62), respectively. Mean diameter of lesions was 17.3mm (10-31 mm) for spiculated masses while non spiculated masses were 15.8mm (6-40 mm). There were statistically significant differences between late phase enhancement, persistent enhancement, plateau and washout (p<0.05). Intergroup comparison of desmoplasia revealed significant difference between severe versus and mild, moderate (p<0.05).
  
  
  CONCLUSIONS
  Spiculated malignant lesions are supposed to contain intense desmoplastic reaction. On DCE-MR images they can show persistent enhancement pattern more often than non-spiculated lesions.
authors.affiliation: Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa 16059, Turkey. drgokhangokalp@yahoo.com
authors.forename: Gokhan
authors.initials: G
authors.lastname: Gokalp
authors.forename: Ugur
authors.initials: U
authors.lastname: Topal
authors.forename: Nalan
authors.initials: N
authors.lastname: Yildirim
authors.forename: Sahsine
authors.initials: S
authors.lastname: Tolunay
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA