The value of breast MRI in the classification of BI-RADS IV subdivisions


  • Zainab Almusawi College of medicine


BI-RADS IV subdivisions, breast MRI, breast cancer


Background: breast cancer is the most common type of cancer among females worldwide and is the most prevalent cancer in Iraq.

Aims: to determine the value of breast MRI in the assessment of BI-RADS IV subdivisions. Trying to reflect the likelihood of malignancy and to determine whether they correspond well to target ranges for mammography and ultrasound (up grading or down-grading).

Patients and methods: a cross-sectional study carried out on selected 32 ladies with 47 suspicious lesions by means of ultrasonography and/ or mammography and were recruited for MRI unit of Al-Imamein Al-Kadhimein Medical city in Baghdad from February 2019 to December 2019. Two independent radiologists analyzed the images; subcategorized the findings as BI-RADS 4A, 4B, or 4C.

Results: from the 47 lesions, 21 were proved malignant, giving sensitivity of 100% and specificity of 34.6%. The referral BI-RADS IV subdivisions by US/ mammography (IVA= 20 (55% of them given IV A on MRI), IVB= 18 (27.7% of them were IVB on MRI) and IVC= 9 (77% were given IV C on MRI)) were significantly correlated to that of DCE- MRI (P-value <0.001). There was statistically significant correlation of lesional size (P- value=0.003), shape (P- value=0.003), margins (P- value < 0.001), type of dynamic curve (P-value = 0.02), T2 signal intensity (P-value= 0.009) with the lesion type (benign or malignant). While patients age, breast density, family history of breast malignancy, background parenchymal enhancement and the location of lesion showed no statistical significant correlation with benignity of a lesion.

Conclusion: risk stratification of suspicious lesions (BI-RADS IV subdivisions) was satisfactorily performed with DCE-MRI as it can concur to U/S and mammography in the assessment of ACR BI-RADS IV subdivisions.


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