Differentiation of bilateral BI-RADS 4 breast lesions with one benign and one malignant finding using dual-layer detector spectral CT: a case report

The differentiation between benign and malignant BI-RADS 4 breast lesions remains a significant clinical challenge, particularly when multi-modal imaging assessments yield inconsistent results, often leading to diagnostic dilemmas. Dual-layer detector spectral computed tomography (CT) (DLCT), as an imaging modality, provides multi-parametric quantitative information and holds promise as a tool for lesion differentiation. Here, we present a case of bilateral breast lesions. Although ultrasound assessed both as BI-RADS 4, subsequent mammography, magnetic resonance imaging (MRI), and CT yielded discordant findings for the right lesion. Retrospective analysis of the preoperative DLCT data clearly revealed the intrinsic differences between the bilateral lesions. This accurately predicted malignancy on the left side and benignity on the right side, which was in complete concordance with the final surgical pathological findings.