Concepts for differential diagnosis in breast MR imaging

There is broad agreement in that breast MR imaging, compared with all other contemporary breast imaging techniques, offers the highest sensitivity for primary and recurrent invasive breast cancer. For a long time, however, the modality suffered from the reputation of offering only a limited specificity. In addition, the allegedly low sensitivity for intraductal breast cancer hampered the more widespread use of breast MR imaging. More recent results, however, suggest that the specificity and positive predictive value of breast MR imaging are at least equivalent to those of mammography and that the sensitivity for ductal carcinoma in situ (DCIS) is at least comparable to mammography, if not higher. Apart from increasing reader experience, this progress is mainly attributable to the fact that in parallel with improved MR imaging technology, more refined interpretation criteria became available. These criteria allow a substantially improved diagnosis of malignant masses and of DCIS. This article provides an overview on the current status of the diagnosis criteria that are used for differential diagnosis in breast MR imaging and on the diagnostic accuracy that is achievable with breast MR imaging.