title: Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation.
abstract: At magnetic resonance (MR) imaging, both normal and abnormal breast tissue enhances after contrast material administration. The morphology and temporal degree of enhancement of pathologic breast tissue relative to normal breast tissue form the basis of MR imaging's diagnostic accuracy in the detection and diagnosis of breast disease. Normal parenchymal enhancement at breast MR imaging is termed background parenchymal enhancement (BPE). BPE may vary in degree and distribution in different patients as well as in the same patient over time. Typically BPE is minimal or mild in overall degree, with a bilateral, symmetric, diffuse distribution and slow early and persistent delayed kinetic features. However, BPE may sometimes be moderate or marked in degree, with an asymmetric or nondiffuse distribution and rapid early and plateau or washout delayed kinetic features. These patterns cause diagnostic difficulty because these features can be seen with malignancy. This article reviews typical and atypical patterns of BPE seen at breast MR imaging. The anatomic and physiologic influences on BPE in women undergoing diagnostic and screening breast MR imaging are reviewed. The potential for false-positive and false-negative interpretations due to BPE are discussed. Radiologists can improve their interpretive accuracy by increasing their understanding of various BPE patterns, influences on BPE, and the potential effects of BPE on MR imaging interpretation.
authors.affiliation: From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Giess
authors.forename: Eren D
authors.initials: ED
authors.lastname: Yeh
authors.forename: Sughra
authors.initials: S
authors.lastname: Raza
authors.forename: Robyn L
authors.initials: RL
authors.lastname: Birdwell
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage*; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media