Eur Radiol (2005) 15: 2010–2017 DOI 10.1007/s00330-005-2755-4 BREAST N. Morakkabati-Spitz C. Leutner H. Schild F. Traeber C. Kuhl Received: 15 December 2004 Revised: 2 March 2005 Accepted: 24 March 2005 Published online: 20 April 2005 # Springer-Verlag 2005 Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI Abstract The aim of this study was the evaluation of the diagnostic use- fulness of ductal or segmental en- hancement in dynamic breast MRI. Segmental and ductal enhancement have been established as the breast MRI hallmarks of intraductal breast cancer (DCIS); however, the positive predictive value of this imaging find- ing is still unknown. In our study, we analysed the overall prevalence of a segmental or a linear enhancement pattern on breast MRI for an unse- lected cohort of patients. The aim was to evaluate the diagnostic usefulness of segmental or linear enhancement. Second, we asked whether biopsy was necessary also in the absence of mammographic findings suggestive of DCIS. Prospective, consecutive evaluation of 1,003 patients under- going bilateral dynamic breast MRI. Studies were interpreted by two experienced breast radiologists. A diagnostic or screening two-view mammogram was available for all patients. Biopsy or short-term breast MRI follow-up was recommended for patients showing a segmental or a linear enhancement pattern on breast MRI. The patients’ final diagnoses were established by imaging guided excisional or core biopsy or by clin- ical plus conventional imaging fol- low-up for a period of 2 years. The prevalence of segmental or linear enhancement was determined for pa- tients with a final diagnosis of benign breast disease compared with those with a diagnosis of breast cancer. One hundred twenty patients had invasive breast cancer, 24 patients had DCIS and 859 patients had unsuspicious breast MRI or benign breast disease. A segmental or a linear enhancement pattern was found for 50/1,003 (5%) patients (17 DCIS, 33 benign breast diseases). Accordingly, the positive predictive value of segmental and linear enhancement is 34% (17/50); the specificity of this criterion is 96% (826/859). For 4/24 (17%) patients, DCIS was visible as segmental or linear enhancement on dynamic breast MRI, whereas no abnormalities were visible on the corresponding mam- mogram. The overall prevalence of a ductal or a segmental enhancement pattern on breast MRI is low. But this finding has a high specificity and a moderate positive predictive value for intraductal neoplastic changes. We conclude that if segmental or linear enhancement is identified on breast MRI further work-up is necessary. We recommend either direct MR-guided vacuum-assisted core biopsy or short- term follow-up breast MRI within 3 months. If ductal enhancement then persists, MR-guided biopsy should be recommended even in the absence of mammographically visible signs of DCIS Keywords Ductal . Enhancement . Breast . Magnetic resonance imaging N. Morakkabati-Spitz (*) . C. Leutner . H. Schild . F. Traeber . C. Kuhl Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany e-mail: n.morakkabati@uni-bonn.de Tel.: +49-228-2875871 Fax: +49-228-2875598