Characteristics of ductal carcinoma in situ in magnetic resonance imaging

Abstract Purpose The aim of this study was to evaluate typical dynamic and morphological characteristics of ductal carcinoma in situ (DCIS) in magnetic resonance imaging (MRI). An optimized diagnosis of DCIS is considered to be valuable for radiologists and clinicians, especially for early and successful treatment planning. Materials and methods Magnetic resonance examinations of 74 patients with pure DCIS were evaluated. Categories were established for signal increase (C1=the same enhancement as glandular tissue; C2=slow and continuous; C3=strong initial and slow further increase; C4=strong initial increase and plateau phenomenon; and C5=strong initial increase followed by a washout phenomenon) and morphological findings (M0=no pattern observed; M1=linear or linear-branched; M2=segmental dotted or granular; M3=segmental homogenous; and M4=focal spotlike). All cases were associated with histopathological results. Results Regarding the 74 DCIS lesions, 37 (50%) showed a signal increase typical of malignancy (C4 and C5). Among all cases, 33.3% of G1 lesions, 68.4% of G2 lesions, and 55.5% of G3 lesions presented a C4 or C5 enhancement. Furthermore, 55.4% ( n =41) showed a segmental dotted enhancement (M2), whereas 17.6% showed a focal spotlike enhancement (M4). The morphological features of the other lesions were as follows: 12.2% homogeneous (M3) and 4.0% linear (M1). In 8 cases (10.8%), no significant pattern was observed (M0). Combining dynamic and morphological characteristics, 68.9% presented an appearance comparable with the appearance of invasive breast cancer in MRI. Conclusions Ductal CIS lesions show typical morphological and kinetic, but heterogeneous, characteristics in MRI, comparable with the histopathological variety of the disease. For detecting pure DCIS cases early and precisely, a combination of dynamic and morphological criteria seems to be important.