Radial scars of the breast: Contrast-enhanced magnetic resonance mammography appearance

The purpose of this study was to evaluate the appearance of contrast-enhanced magnetic resonance mammography (CE-MRM) in patients with suspected radial scar on mammography. Thirty women with radial opacities or black star findings at mammography, preoperatively underwent CE-MRM. Examinations were performed with a 1.5 T magnet with a bilateral surface coil using a FS T2-weighted turbo spin echo (TSE) and three-dimensional (3D) dynamic T1-weighted fast low-angle shot (FLASH) sequences. Criteria for lesion evaluation included morphologic patterns and signal intensity curves. Mammography and CE-MRM findings were compared with pathologic findings. CE-MRM suggested the presence of radial scar in 18 of 30 cases and the presence of malignancy in 11 of 30 cases; 1 lesion was classified as borderline. At surgery 22 radial scars (including 4 with associated ductal carcinoma in situ) and 8 carcinomas were detected. CE-MRM provided a specificity of 89%, sensitivity of 83%, and accuracy of 87%. Differently from breast cancer, radial scars are nonenhancing at CE-MRM. Nevertheless, the possibility of nonenhancing carcinomatous foci existing within radial scars implies that surgical excision should be performed in all cases.