Evaluation of T2 weighted hyperintense lesions on breast MRI: Imaging characteristics and histopathology correlation

Objectives To evaluate the imaging characteristics of T2-weighted hyperintense lesions on T1WI, dynamic contrast Fat Sat T1WI, and the correlation of these features with histopathology findings. Materials and Methods This is a retrospective observational study carried out in a tertiary care hospital. MRI breast images were analyzed in 107 T2W hyperintense lesions. The imaging characteristics in the form of signal intensity, shape, margins, and kinetic pattern were evaluated, and the findings were correlated with histopathology findings. Results Out of the 107 lesions, 86 (80.4%) were benign and 21 (19.6%) were malignant. The most common benign pathology was fibroadenoma (33.7%), followed by cysts (20.9%) and infection or abscess (18.6%). The most common malignant pathology was invasive ductal carcinoma (42.8%), followed by papillary carcinoma (19%) and mucinous cancer (14.2%). The most common shape was irregular, which was present in 47.6% (n = 51, 34 benign and 17 malignant), followed by the oval shape at 39.2% (n = 42, 39 benign and 3 malignant). Circumscribed margins were seen in 67% of masses (n = 72, 69 benign, 3 malignant), and spiculated margins were observed in 52.4% of malignant masses. Type I kinetic curve was seen in 54.21% (n = 58) of lesions, type II in 32.71% (n = 35), and a type III in 13.08% (n = 14). Twelve out of 21 malignant lesions showed type III curve, and 58 out of 86 benign lesions showed a type I curve. Conclusion The T2WI sequence is useful in evaluating breast masses on MRI. It helps diagnose edema, cysts, fat, fluid collection, hemorrhage, and tumor necrosis in the breast lesions. Malignant lesions of mucinous, papillary, and medullary cancers demonstrate hyperintense signal intensities on T2-weighted imaging, and these findings aid the diagnosis of these cases in clinical practice. The T2W imaging sequence in the abbreviated protocol improves the diagnostic accuracy.