Case 55 Answer 3
A single irregular enhancing mass is present in a background of benign 2-3 mm foci of progressive enhancement. The patient went on to have lumpectomy and radiation, and is doing well.
It is obviously unfair to ask you to assess an MRI from 2 images when I had the advantage of looking at all 1500 images! A full discussion of MR imaging is beyond the scope of this teaching case (stay tuned for a new MRI teaching set), but it is common to see scattered stippled progressive (increasing on time curves) enhancement or small 2-3 mm foci of progressive enhancement in benign tissue. If this is a diffuse bilateral and symmetric pattern, it, like a similar pattern with calcifications, is considered benign.
Masses with irregular or spiculated margins, heterogeneous enhancement, irregular rim enhancement, and washout on delayed images are suspicious for malignancy.