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Usefulness of MRI in detecting occult breast cancer associated with Paget's disease of the nipple–areolar complex

Section of Breast Imaging of the ¹ Department of Radiology, ² OSATEK MRI, ³ Department of Pathology and ⁴ Department of Gynaecology, Galdakao Hospital, Barrio Labeaga s/n 48960 Galdakao, Vizcaya, Spain

View larger version (73K): [in a new window]   Figure 1. Maximum intensity projections in axial projection. The left breast demonstrates prominent vascularization and the nipple–areolar complex is seen as an intensely enhanced discoidal mass (arrow), when compared with the contralateral normal side (arrowhead).

View larger version (23K): [in a new window]   Figure 2. Study of the enhancement of the (a) left and (b) right nipple. Subtraction sequence in coronal projection. The left nipple is enlarged and there is intense early enhancement of 90% during the first 2 min after contrast medium (vertical line on the curve), followed by a plateau. On the right, healthy side, the enhancement curve is progressive and the late enhancement peak reaches approximately 60%.

View larger version (109K): [in a new window]   Figure 3. Gradient echo water excitation 3D T1 weighted sequence. Thickening of the skin of the areola and nipple and ectasia of the major lactiferous ducts (arrowheads) is observed, as well as clumped linear enhancing foci in deep breast tissue (arrow).

View larger version (101K): [in a new window]   Figure 4. Multiplanar reconstruction in oblique-lateral projection. Gradient echo fat suppressed 3D contrast enhanced T1 weighted sequence. Two smooth oval homogeneous masses (arrows). Although the characteristics indicated probably benign nodules, the presence of Paget's disease suggested the possibility of two small neoplastic foci.