Enhancement of the Nipple-Areolar-Complex on Contrast-Enhanced MR Imaging of the Breast

OBJECTIVE: To evaluate patterns of enhancement in the nipple-areolar-complex (NAC) on contrast-enhanced MRI. METHODS: We reviewed the MR images of 37 patients in which enhancement of the NAC was demonstrated on gadolinium-enhanced dynamic fast radiofrequency spoiled gradient recalled echo (fast-SPGR) images. Time intensity profiles derived from signal intensity values were constructed, and findings correlated with histological results. RESULTS: Three types of curve were observed. In the first type seen in adenoma of the nipple, rapid initial increase in signal intensity with an early peak (1 min) occurred followed by gradual washout. In the second type seen in direct invasion from carcinoma, subareolar intracystic papilloma, or Paget's disease, rapid initial increase in signal intensity followed by a more gradual increase or plateau was seen. In the third type seen in carcinoma without nipple invasion, fibrocystic disease and fibroadenoma, a gradual increase in signal intensity was observed throughout the examination period. CONCLUSION: Early and prominent enhancement of the NAC on contrast-enhanced MRImay indicate the presence of a primary lesion in the NAC or secondary involvement by a primary tumor elsewhere in the breast.