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Breast MRI for Cancer Detection in a Patient with Diabetic Mastopathy

Helena A. Gabriel1, Chun Feng, Ellen B. Mendelson and Stefanie Benjamin

1 All authors: Department of Radiology, Northwestern University Medical School, 676 North St. Clair St., Ste. 800, Chicago, IL 60611.



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  		Fig. 1A. —40-year-old woman with diabetic mastopathy. Bilateral mediolateral oblique mammograms show dense fibroglandular tissue with minimally increased density in superior aspect of left breast (arrow).

 


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  		Fig. 1B. —40-year-old woman with diabetic mastopathy. Sonogram of questionable palpable thickening of upper outer left quadrant shows nonspecific areas of shadowing, thought to be related to diabetic mastopathy. No cysts or solid masses are seen.

 


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  		Fig. 1C. —40-year-old woman with diabetic mastopathy. STIR axial MR image (TR/TE, 5,700/72) shows marked asymmetry in appearance of breasts. Left breast has diffusely increased signal within parenchyma and skin, suggesting diffuse breast edema and skin thickening (arrow).

 


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  		Fig. 1D. —40-year-old woman with diabetic mastopathy. Dynamic sagittal T1-weighted 3D gradient-echo MR image obtained after contrast enhancement reveals lobulated 2.4 x 1.9 cm mass in upper outer left quadrant. This mass has heterogeneous contrast agent uptake with enhancing septa in spiculated configuration (arrowhead) and enhancing thin peripheral rim.

 


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  		Fig. 1E. —40-year-old woman with diabetic mastopathy. Subtraction sagittal T1-weighted 3D gradient-echo MR image again shows dominant mass (arrowhead) and other diffuse reticular areas of enhancement and nodularity (straight arrows), suggesting diffuse tumor infiltration. Note skin enhancement (curved arrow), suggesting dermal lymphatic invasion.

 


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  		Fig. 1F. —40-year-old woman with diabetic mastopathy. Graph of MRI time–signal intensity curves from MR image with mean enhancement plotted on y-axis against time on x-axis shows distinctive enhancement kinetics of mass. Curve of dominant lobulated mass shows washout of contrast agent, which is suspicious for malignancy.

 

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