Mark Knox MBBCh, Presenter: Nothing to Disclose

Priscilla Jennings Slanetz MD, MPH, Abstract Co-Author: Nothing to Disclose

Richard Earnest Sharpe MD, MBA, Abstract Co-Author: Nothing to Disclose

Vandana Mukesh Dialani MD, Abstract Co-Author: Nothing to Disclose

Shambhavi Venkataraman MD, Abstract Co-Author: Nothing to Disclose

Jordana Phillips MD, Abstract Co-Author: Nothing to Disclose

Valerie J. Fein-Zachary MD, Abstract Co-Author: Research Consultant, Siemens AG

Tejas S. Mehta MD, MPH, Abstract Co-Author: Nothing to Disclose

Incidental hepatic lesions identified on breast MR can be a diagnostic dilemma due to concern for liver metastases or other significant hepatic lesions. The purpose of this study was to identify the incidence and nature of liver lesions seen on breast MR, and determine whether additional imaging or follow up may be necessary.

From 1/1/10-12/31/11,1664 breast MR studies were performed. The medical records and imaging of all patients were reviewed for the presence of liver lesions, if an accurate diagnosis was made on breast MRI, how often further imaging was recommended, and the final diagnosis upon additional imaging.

Of 1664 breast MRs, incidental hepatic lesions were seen in 207 (12.4%). In 162 MRs (78%) these were reported as circumscribed T2 hyperintense lesions consistent with cysts or hemangiomas. No diagnosis was made on breast MR in 43 cases (21%) and lesions were described as suspicious for metastases in 2 cases (1.0%). Further imaging was recommended in 50/162 patients (31%) with lesions described as cysts or hemangiomas and 29/43 patients (67%) with lesions for which no diagnosis was made. Of these 79 patients, further imaging was performed in 60 patients (76%), 19 patients (24%) did not have subsequent imaging or were lost to follow-up. Further imaging confirmed the diagnosis of a cyst or hemangioma in 53/60 patients (88%), with no lesion identified in 5/60 patients (8%). 2 patients (3%) had lesions that were categorized as indeterminate on MRI but were stable at 1-year follow-up. The 2 patients with hepatic lesions suspicious for metastases both had mildly T2 hyperintense hepatic lesions confirmed as metastases at subsequent imaging. Both patients had locally advanced breast cancer on MR.  

The majority of incidental liver lesions on breast MR can be classified as cysts or hemangiomas without further imaging. Of patients undergoing further imaging, 96% of patients had benign findings and 3% had lesions characterized as indeterminate but stable on follow up. In 2 cases (1%), T2 mildly hyperintense hepatic lesions were correctly identified as metastases on breast MR. Our series suggests further imaging may not be necessary for incidental benign appearing lesions seen on breast MR.

Breast MR detects incidental liver lesions in 12% of patients, the majority of which are benign. This suggests that additional dedicated hepatic imaging may not be necessary.

Knox, M, Slanetz, P, Sharpe, R, Dialani, V, Venkataraman, S, Phillips, J, Fein-Zachary, V, Mehta, T, Are Incidental Hepatic Lesions on Breast MRI Clinically Significant?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015849.html