Breast MRI of multifocal breast cancer

Breast MRI can be useful for determining disease extent in newly diagnosed cancer patients. These images show the MRI of a patient with a palpable retroareolar mass.

(A) T2-weighted imaging demonstrates an intermediate signal irregular mass just beneath the nipple as well as a T2-hypointense area posteriorly (arrows).

(B) Post contrast T1-weighted sagittal image demonstrates a suspiciously enhancing lesion in the inferior subareolar breast as well as an ill-defined area of non-mass enhancement posteriorly within the same ductal unit (arrows).

(C) Subtraction of pre- and post-contrast images confirm the two separate lesions with the posterior lesion being occult to both mammography and ultrasound. Biopsy of both areas was performed, revealing invasive ductal carcinoma anteriorly and ductal carcinoma in situ posteriorly.