Breast Magnetic Resonance Imaging as a Problem-Solving Tool in Patients with Mammographic Architectural Distortion

Öz

Architectural distortion detected on full-field digital mammography represents a significant diagnostic challenge due to its association with both benign and malignant pathologies. This retrospective study evaluated the diagnostic performance of breast magnetic resonance imaging (MRI) in differentiating benign and malignant lesions in patients with mammographic architectural distortion. Sixty-two patients (age range, 27–78 years; median, 48 years) examined between January 2020 and March 2021 were included. Histopathological confirmation was available for 36 lesions, while 26 benign lesions were validated by at least two years of imaging follow-up. MRI features analyzed included lesion type, margin characteristics, internal enhancement pattern, background parenchymal enhancement, T2 signal intensity, diffusion restriction, apparent diffusion coefficient (ADC) values, and kinetic curve type. Of the evaluated lesions, 17 were malignant and 19 were benign. Malignancy was significantly associated with non-circumscribed margins, heterogeneous or rim enhancement, diffusion restriction, low ADC values, and wash-out kinetic patterns, whereas benign lesions were more frequently characterized by high T2 signal intensity and homogeneous enhancement (all p < 0.05). Minimal background parenchymal enhancement was more common in malignant cases, while marked enhancement was observed exclusively in benign lesions. MRI showed limited ability to reliably differentiate radial scars from invasive carcinoma. Overall, breast MRI provided additional diagnostic value in the evaluation of mammographic architectural distortion. A multiparametric approach integrating morphologic, functional, and dynamic MRI features improved diagnostic accuracy and may help reduce unnecessary biopsies, while highlighting key imaging predictors of malignancy.

Anahtar Kelimeler

• Architectural distortion
• diffusion-weighted imaging
• kinetic curve analysis
• apparent diffusion coefficient
• breast magnetic resonance imaging

Mamografide Saptanan Yapısal Bozulmalarda Meme Manyetik Rezonans Görüntülemenin Tanısal Sorun Çözücü Rolü

Öz

Tam alan dijital mamografide saptanan yapısal bozulma, hem benign hem de malign patolojilerle ilişkili olabilmesi nedeniyle önemli bir tanısal güçlük oluşturmaktadır. Bu retrospektif çalışmada, mamografide yapısal bozulma saptanan hastalarda benign ve malign lezyonların ayırt edilmesinde meme manyetik rezonans görüntülemenin (MRG) tanısal performansı değerlendirilmiştir. Ocak 2020–Mart 2021 tarihleri arasında incelenen 62 hasta (yaş aralığı 27–78, medyan 48) çalışmaya dahil edilmiştir. Otuz altı lezyon histopatolojik olarak doğrulanmış, 26 benign lezyon ise en az iki yıllık görüntüleme takibi ile teyit edilmiştir. MRG’de lezyon tipi, kenar özellikleri, internal kontrastlanma paterni, arka plan parankimal kontrastlanma düzeyi, T2 sinyal intensitesi, difüzyon kısıtlılığı, görünür difüzyon katsayısı (ADC) değerleri ve kinetik eğri tipi değerlendirilmiştir. Değerlendirilen lezyonların 17’si malign, 19’u benign olarak saptanmıştır. Malignite; düzensiz kenar, heterojen veya rim tarzı kontrastlanma, difüzyon kısıtlılığı, düşük ADC değerleri ve wash-out kinetik patern ile anlamlı düzeyde ilişkili bulunurken, benign lezyonlar daha sıklıkla yüksek T2 sinyal intensitesi ve homojen kontrastlanma göstermiştir (tümü p<0,05). Minimal arka plan parankimal kontrastlanma malignite ile ilişkiliyken, belirgin kontrastlanma yalnızca benign olgularda izlenmiştir. Meme MRG, radial skar ile invaziv karsinom ayrımında sınırlı bir ayırt edici performans göstermiştir. Sonuç olarak, mamografide saptanan yapısal bozulmaların değerlendirilmesinde meme MRG ek tanısal katkı sağlamaktadır. Morfolojik, fonksiyonel ve dinamik özelliklerin birlikte değerlendirildiği multiparametrik yaklaşım tanısal doğruluğu artırabilir ve gereksiz biyopsilerin azaltılmasına katkıda bulunabilirken, malignite için önemli görüntüleme belirteçlerini de vurgulamaktadır.

Anahtar Kelimeler

• Yapısal bozulma
• meme manyetik rezonans görüntüleme;
• difüzyon ağırlıklı görüntüleme
• görünür difüzyon katsayısı
• kinetik eğri analizi.

Kaynakça

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