Clinical Scorecard: Influence of Background Parenchymal Enhancement on the Identification of Enhancing Lesions in Breast MRI: A Systematic Review
At a Glance
Category
Detail
Condition
Breast cancer detection using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)
Key Mechanisms
Background parenchymal enhancement (BPE) represents normal breast tissue enhancement influenced by hormonal levels and vascular factors, potentially masking or mimicking lesions on MRI
Target Population
Women undergoing breast MRI for screening or diagnostic evaluation with non-specific or suspicious mammography/ultrasound findings
Care Setting
Radiology departments performing breast MRI with DCE protocols
Key Highlights
BPE is categorized by ACR BI-RADS as minimal, mild, moderate, or marked based on percentage of glandular tissue enhancement.
BPE varies with menstrual cycle, steroid hormone levels, and vascular factors, and may present in various enhancement patterns.
Higher BPE levels may increase abnormal interpretation rates but have controversial impact on final diagnostic accuracy.
Guideline-Based Recommendations
Diagnosis
Assess BPE on the first postcontrast subtraction image according to ACR BI-RADS MRI lexicon.
Use region-of-interest (ROI) based analysis dividing each breast into 5 volumetric regions for lesion localization and classification.
Consider patient menopausal status and hormonal influences when interpreting BPE.
Management
Exclude patients with contraindications to gadolinium contrast or prior chemotherapy/antihormonal treatment for accurate BPE assessment.
Perform multiparametric breast MRI including T1-weighted pre- and post-contrast sequences and diffusion-weighted imaging.
Monitoring & Follow-up
Monitor BPE variability over menstrual cycle and time course of dynamic scanning.
Use standardized timing for postcontrast imaging to ensure consistent BPE assessment.
Risks
High BPE may mask or mimic suspicious lesions, potentially leading to false positives or negatives.
Variability in BPE can complicate lesion detection and interpretation.
Patient & Prescribing Data
Women undergoing breast MRI for screening or diagnostic evaluation with suspicious or non-specific findings on mammography or ultrasound
BPE assessment should be integrated into MRI interpretation to improve lesion detection accuracy; exclusion criteria include renal insufficiency, gadolinium allergy, pregnancy, breastfeeding, and prior chemotherapy or antihormonal therapy.
Clinical Best Practices
Standardize BPE assessment using ACR BI-RADS categories on early postcontrast images.
Employ ROI-based lesion localization to improve diagnostic accuracy at lesion level.
Ensure radiologists interpreting breast MRI have specialized training and experience in breast imaging.
Use multiparametric MRI protocols including diffusion-weighted imaging and ADC mapping.
Consider hormonal status and timing of MRI relative to menstrual cycle to interpret BPE variability.
