title: MRI findings of radiation-associated angiosarcoma of the breast (RAS).
abstract: OBJECTIVE
  To describe the magnetic resonance imaging (MRI) characteristics of radiation-associated breast angiosarcomas (RAS).
  
  
  METHODS
  In this Institutional Review board (IRB)-approved retrospective study, 57 women were diagnosed with pathologically confirmed RAS during the study period (January 1999 to May 2013). Seventeen women underwent pretreatment breast MRI (prior to surgical resection or chemotherapy), of which 16 studies were available for review. Imaging features, including all available mammograms, ultrasounds, and breast MRIs, of these patients were evaluated by two radiologists independently and correlated with clinical management and outcomes.
  
  
  RESULTS
  The median age of patients at original breast cancer diagnosis was 69.3 years (range 42-84 years), with average time from initial radiation therapy to diagnosis of RAS of 7.3 years (range 5.1-9.5 years). Nine women had mammograms (9/16, 56%) and six had breast ultrasound (US) (6/16, 38%) prior to MRI, which demonstrated nonsuspicious findings in 5/9 mammograms and 3/6 ultrasounds. Four patients had distinct intraparenchymal masses on mammogram and MRI. MRI findings included diffuse T2 high signal skin thickening (16/16, 100%). Nearly half (7/16, 44%) of patients had T2 low signal intensity lesions; all lesions rapidly enhanced on postcontrast T1 -weighted imaging. All women underwent surgical resection, with 8/16 (50%) receiving neoadjuvant chemotherapy. Four women died during the study period.
  
  
  CONCLUSIONS
  Clinical, mammographic, and sonographic findings of RAS are nonspecific and may be occult on conventional breast imaging; MRI findings of RAS include rapidly enhancing dermal and intraparenchymal lesions, some of which are low signal on T2 weighted imaging.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Sona A
authors.initials: SA
authors.lastname: Chikarmane
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Imaging, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Eva C
authors.initials: EC
authors.lastname: Gombos
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Jayender
authors.initials: J
authors.lastname: Jagadeesan
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Chandrajit
authors.initials: C
authors.lastname: Raut
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jyothi P
authors.initials: JP
authors.lastname: Jagannathan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy; D003287:Contrast Media / Q000737:chemistry; D005260:Female; D006394:Hemangiosarcoma / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis* / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary
chemical_list: D003287:Contrast Media
keywords: angiosarcoma; breast magnetic resonance imaging; radiation-associated