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MR Ductography: Comparison with Conventional Ductography as a Diagnostic Method in Patients with Nipple Discharge¹

¹ From the Department of Radiology, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666 Tokyo, Japan. Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received February 1, 2007; revision requested March 13; final revision received May 14; accepted May 30. All authors have no financial relationships to disclose.

View larger version (72K): [in this window] [in a new window] [Download PPT slide]   Figure 1.  Intraductal papilloma in a 40-year-old woman. Conventional ductogram shows a lobulated filling defect (arrow) within a dilated duct. The contrast material–filled duct is completely obstructed.

 

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 2.  Intraductal papilloma in a 54-year-old woman. Conventional ductogram shows a lobulated filling defect (arrow), which almost completely obstructs the contrast material–filled duct.

 

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Intraductal papilloma in a 28-year-old woman. (a) MR ductogram shows a lobulated signal defect (arrow) within a dilated duct. (b) MR mammogram shows a well-circumscribed, lobulated, enhancing mass (arrow).

 

View larger version (90K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Intraductal papilloma in a 28-year-old woman. (a) MR ductogram shows a lobulated signal defect (arrow) within a dilated duct. (b) MR mammogram shows a well-circumscribed, lobulated, enhancing mass (arrow).

 

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  Ductal carcinoma in situ in a 49-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) conventional ductograms show ductal irregularity (black arrow), encasement (white arrow in a), and obstruction (white arrowhead) and an irregular filling defect (black arrowhead). (c) MR mammogram shows enhancing lesions along the ducts (arrows).

 

View larger version (93K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  Ductal carcinoma in situ in a 49-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) conventional ductograms show ductal irregularity (black arrow), encasement (white arrow in a), and obstruction (white arrowhead) and an irregular filling defect (black arrowhead). (c) MR mammogram shows enhancing lesions along the ducts (arrows).

 

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 4c.  Ductal carcinoma in situ in a 49-year-old woman. (a, b) Mediolateral oblique (a) and craniocaudal (b) conventional ductograms show ductal irregularity (black arrow), encasement (white arrow in a), and obstruction (white arrowhead) and an irregular filling defect (black arrowhead). (c) MR mammogram shows enhancing lesions along the ducts (arrows).

 

View larger version (65K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  Invasive ductal carcinoma in a 40-year-old woman with a bloody nipple discharge. (a) Conventional ductogram shows a dilated and obstructed duct (arrowheads) with an irregular wall and multiple filling defects with irregular surfaces. A cyst with a filling defect (arrow) communicates with the discharging ductal system. (b) MR ductogram (maximum intensity projection [MIP] image) shows multiple cystic and irregularly dilated ducts. The cystic areas appear as high-signal-intensity nodules. (c) MR mammogram (MIP image) shows a diffusely enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the extent of the carcinoma (yellow) surrounding the dilated ducts (green).

 

View larger version (90K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  Invasive ductal carcinoma in a 40-year-old woman with a bloody nipple discharge. (a) Conventional ductogram shows a dilated and obstructed duct (arrowheads) with an irregular wall and multiple filling defects with irregular surfaces. A cyst with a filling defect (arrow) communicates with the discharging ductal system. (b) MR ductogram (maximum intensity projection [MIP] image) shows multiple cystic and irregularly dilated ducts. The cystic areas appear as high-signal-intensity nodules. (c) MR mammogram (MIP image) shows a diffusely enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the extent of the carcinoma (yellow) surrounding the dilated ducts (green).

 

View larger version (105K): [in this window] [in a new window] [Download PPT slide]   Figure 5c.  Invasive ductal carcinoma in a 40-year-old woman with a bloody nipple discharge. (a) Conventional ductogram shows a dilated and obstructed duct (arrowheads) with an irregular wall and multiple filling defects with irregular surfaces. A cyst with a filling defect (arrow) communicates with the discharging ductal system. (b) MR ductogram (maximum intensity projection [MIP] image) shows multiple cystic and irregularly dilated ducts. The cystic areas appear as high-signal-intensity nodules. (c) MR mammogram (MIP image) shows a diffusely enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the extent of the carcinoma (yellow) surrounding the dilated ducts (green).

 

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 5d.  Invasive ductal carcinoma in a 40-year-old woman with a bloody nipple discharge. (a) Conventional ductogram shows a dilated and obstructed duct (arrowheads) with an irregular wall and multiple filling defects with irregular surfaces. A cyst with a filling defect (arrow) communicates with the discharging ductal system. (b) MR ductogram (maximum intensity projection [MIP] image) shows multiple cystic and irregularly dilated ducts. The cystic areas appear as high-signal-intensity nodules. (c) MR mammogram (MIP image) shows a diffusely enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the extent of the carcinoma (yellow) surrounding the dilated ducts (green).

 

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  Intraductal papilloma in a 75-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated duct with a filling or signal defect (arrow), which represents an intraductal papilloma. (c) MR mammogram (MIP image) shows a well-circumscribed enhancing lesion (arrow), which represents the tiny papilloma. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal lesion (red). (Fig 6a–6c reprinted, with permission, from reference 7.)

 

View larger version (73K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  Intraductal papilloma in a 75-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated duct with a filling or signal defect (arrow), which represents an intraductal papilloma. (c) MR mammogram (MIP image) shows a well-circumscribed enhancing lesion (arrow), which represents the tiny papilloma. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal lesion (red). (Fig 6a–6c reprinted, with permission, from reference 7.)

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 6c.  Intraductal papilloma in a 75-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated duct with a filling or signal defect (arrow), which represents an intraductal papilloma. (c) MR mammogram (MIP image) shows a well-circumscribed enhancing lesion (arrow), which represents the tiny papilloma. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal lesion (red). (Fig 6a–6c reprinted, with permission, from reference 7.)

 

View larger version (91K): [in this window] [in a new window] [Download PPT slide]   Figure 6d.  Intraductal papilloma in a 75-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated duct with a filling or signal defect (arrow), which represents an intraductal papilloma. (c) MR mammogram (MIP image) shows a well-circumscribed enhancing lesion (arrow), which represents the tiny papilloma. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal lesion (red). (Fig 6a–6c reprinted, with permission, from reference 7.)

 

View larger version (84K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  Intraductal papilloma in a 46-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a slightly dilated and completely obstructed duct with a filling or signal defect (arrow). The extent of the intraductal lesion is not demonstrated. On the MR ductogram, the small bright lesion deep to the fluid-filled duct may be a tiny cyst, and the tubular bright lesion (arrowhead in b) is a vessel. (c) MR mammogram shows the intraductal lesion as a linear enhancing lesion (arrow) and demonstrates its exact size. (d) Three-dimensional fusion image shows the slightly dilated duct (green) and the precise location and extent of the intraductal papilloma (red).

 

View larger version (83K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  Intraductal papilloma in a 46-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a slightly dilated and completely obstructed duct with a filling or signal defect (arrow). The extent of the intraductal lesion is not demonstrated. On the MR ductogram, the small bright lesion deep to the fluid-filled duct may be a tiny cyst, and the tubular bright lesion (arrowhead in b) is a vessel. (c) MR mammogram shows the intraductal lesion as a linear enhancing lesion (arrow) and demonstrates its exact size. (d) Three-dimensional fusion image shows the slightly dilated duct (green) and the precise location and extent of the intraductal papilloma (red).

 

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 7c.  Intraductal papilloma in a 46-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a slightly dilated and completely obstructed duct with a filling or signal defect (arrow). The extent of the intraductal lesion is not demonstrated. On the MR ductogram, the small bright lesion deep to the fluid-filled duct may be a tiny cyst, and the tubular bright lesion (arrowhead in b) is a vessel. (c) MR mammogram shows the intraductal lesion as a linear enhancing lesion (arrow) and demonstrates its exact size. (d) Three-dimensional fusion image shows the slightly dilated duct (green) and the precise location and extent of the intraductal papilloma (red).

 

View larger version (127K): [in this window] [in a new window] [Download PPT slide]   Figure 7d.  Intraductal papilloma in a 46-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a slightly dilated and completely obstructed duct with a filling or signal defect (arrow). The extent of the intraductal lesion is not demonstrated. On the MR ductogram, the small bright lesion deep to the fluid-filled duct may be a tiny cyst, and the tubular bright lesion (arrowhead in b) is a vessel. (c) MR mammogram shows the intraductal lesion as a linear enhancing lesion (arrow) and demonstrates its exact size. (d) Three-dimensional fusion image shows the slightly dilated duct (green) and the precise location and extent of the intraductal papilloma (red).

 

View larger version (62K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  Intraductal papilloma in a 40-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram obtained in April 2004 (MIP image) (b) show a dilated duct with a lobulated filling or signal defect (arrow) just below the nipple. (c) MR mammogram (MIP image) shows an enhancing intraductal lesion (arrow) just below the nipple. No other enhancing lesion is seen. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal papilloma (red). (e, f) Follow-up MR ductograms (MIP images) obtained in September 2004 (e) and April 2006 (f) show no significant interval change in the papilloma (arrow). (Fig 8a–8d reprinted, with permission, from reference 7.)

 

View larger version (62K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  Intraductal papilloma in a 40-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram obtained in April 2004 (MIP image) (b) show a dilated duct with a lobulated filling or signal defect (arrow) just below the nipple. (c) MR mammogram (MIP image) shows an enhancing intraductal lesion (arrow) just below the nipple. No other enhancing lesion is seen. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal papilloma (red). (e, f) Follow-up MR ductograms (MIP images) obtained in September 2004 (e) and April 2006 (f) show no significant interval change in the papilloma (arrow). (Fig 8a–8d reprinted, with permission, from reference 7.)

 

View larger version (59K): [in this window] [in a new window] [Download PPT slide]   Figure 8c.  Intraductal papilloma in a 40-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram obtained in April 2004 (MIP image) (b) show a dilated duct with a lobulated filling or signal defect (arrow) just below the nipple. (c) MR mammogram (MIP image) shows an enhancing intraductal lesion (arrow) just below the nipple. No other enhancing lesion is seen. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal papilloma (red). (e, f) Follow-up MR ductograms (MIP images) obtained in September 2004 (e) and April 2006 (f) show no significant interval change in the papilloma (arrow). (Fig 8a–8d reprinted, with permission, from reference 7.)

 

View larger version (97K): [in this window] [in a new window] [Download PPT slide]   Figure 8d.  Intraductal papilloma in a 40-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram obtained in April 2004 (MIP image) (b) show a dilated duct with a lobulated filling or signal defect (arrow) just below the nipple. (c) MR mammogram (MIP image) shows an enhancing intraductal lesion (arrow) just below the nipple. No other enhancing lesion is seen. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal papilloma (red). (e, f) Follow-up MR ductograms (MIP images) obtained in September 2004 (e) and April 2006 (f) show no significant interval change in the papilloma (arrow). (Fig 8a–8d reprinted, with permission, from reference 7.)

 

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 8e.  Intraductal papilloma in a 40-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram obtained in April 2004 (MIP image) (b) show a dilated duct with a lobulated filling or signal defect (arrow) just below the nipple. (c) MR mammogram (MIP image) shows an enhancing intraductal lesion (arrow) just below the nipple. No other enhancing lesion is seen. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal papilloma (red). (e, f) Follow-up MR ductograms (MIP images) obtained in September 2004 (e) and April 2006 (f) show no significant interval change in the papilloma (arrow). (Fig 8a–8d reprinted, with permission, from reference 7.)

 

View larger version (78K): [in this window] [in a new window] [Download PPT slide]   Figure 8f.  Intraductal papilloma in a 40-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram obtained in April 2004 (MIP image) (b) show a dilated duct with a lobulated filling or signal defect (arrow) just below the nipple. (c) MR mammogram (MIP image) shows an enhancing intraductal lesion (arrow) just below the nipple. No other enhancing lesion is seen. (d) Three-dimensional fusion image shows the dilated duct (green) and the intraductal papilloma (red). (e, f) Follow-up MR ductograms (MIP images) obtained in September 2004 (e) and April 2006 (f) show no significant interval change in the papilloma (arrow). (Fig 8a–8d reprinted, with permission, from reference 7.)

 

View larger version (73K): [in this window] [in a new window] [Download PPT slide]   Figure 9a.  Atypical hyperplasia in a 64-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated and obstructed duct with a filling or signal defect (arrow). The number of intraductal lesions and their extents are not demonstrated. (c) MR mammogram (MIP image) shows tiny enhancing nodules (arrows), which represent atypical hyperplasia. (d) Three-dimensional fusion image shows the dilated duct (green) and the five tiny lesions (red), two of which are intraductal.

 

View larger version (61K): [in this window] [in a new window] [Download PPT slide]   Figure 9b.  Atypical hyperplasia in a 64-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated and obstructed duct with a filling or signal defect (arrow). The number of intraductal lesions and their extents are not demonstrated. (c) MR mammogram (MIP image) shows tiny enhancing nodules (arrows), which represent atypical hyperplasia. (d) Three-dimensional fusion image shows the dilated duct (green) and the five tiny lesions (red), two of which are intraductal.

 

View larger version (98K): [in this window] [in a new window] [Download PPT slide]   Figure 9c.  Atypical hyperplasia in a 64-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated and obstructed duct with a filling or signal defect (arrow). The number of intraductal lesions and their extents are not demonstrated. (c) MR mammogram (MIP image) shows tiny enhancing nodules (arrows), which represent atypical hyperplasia. (d) Three-dimensional fusion image shows the dilated duct (green) and the five tiny lesions (red), two of which are intraductal.

 

View larger version (76K): [in this window] [in a new window] [Download PPT slide]   Figure 9d.  Atypical hyperplasia in a 64-year-old woman. (a, b) Conventional ductogram (a) and MR ductogram (MIP image) (b) show a dilated and obstructed duct with a filling or signal defect (arrow). The number of intraductal lesions and their extents are not demonstrated. (c) MR mammogram (MIP image) shows tiny enhancing nodules (arrows), which represent atypical hyperplasia. (d) Three-dimensional fusion image shows the dilated duct (green) and the five tiny lesions (red), two of which are intraductal.

 

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  Fibrocystic disease in a 25-year-old woman. (a) Conventional ductogram shows an obstructed duct (arrow) but no other abnormality. (b) MR ductogram (MIP image) shows the dilated duct (arrow), as well as multiple cystic dilated ducts (arrowhead) that were not seen at conventional ductography. (c) Fusion image shows the dilated ducts (green) and fibrocystic disease (red). (Fig 10a and 10b reprinted, with permission, from reference 7.)

 

View larger version (72K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  Fibrocystic disease in a 25-year-old woman. (a) Conventional ductogram shows an obstructed duct (arrow) but no other abnormality. (b) MR ductogram (MIP image) shows the dilated duct (arrow), as well as multiple cystic dilated ducts (arrowhead) that were not seen at conventional ductography. (c) Fusion image shows the dilated ducts (green) and fibrocystic disease (red). (Fig 10a and 10b reprinted, with permission, from reference 7.)

 

View larger version (57K): [in this window] [in a new window] [Download PPT slide]   Figure 10c.  Fibrocystic disease in a 25-year-old woman. (a) Conventional ductogram shows an obstructed duct (arrow) but no other abnormality. (b) MR ductogram (MIP image) shows the dilated duct (arrow), as well as multiple cystic dilated ducts (arrowhead) that were not seen at conventional ductography. (c) Fusion image shows the dilated ducts (green) and fibrocystic disease (red). (Fig 10a and 10b reprinted, with permission, from reference 7.)

 

View larger version (70K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.  Nondilated duct in a 38-year-old woman with a clear nipple discharge. (a) Conventional ductogram shows a nondilated duct (arrow). (b) MR ductogram (MIP image) does not show the duct.

 

View larger version (76K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.  Nondilated duct in a 38-year-old woman with a clear nipple discharge. (a) Conventional ductogram shows a nondilated duct (arrow). (b) MR ductogram (MIP image) does not show the duct.

 

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 12a.  Invasive ductal carcinoma in a 44-year-old woman with a bloody nipple discharge. (a) MR ductogram (MIP image) shows no dilated duct. (b) Precontrast T1-weighted MR mammogram (MIP image) shows a high-signal-intensity structure (arrows), which represents a dilated duct. (c) Postcontrast MR mammogram (MIP image) shows an enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the relationship between the dilated ducts (green) and the carcinoma (red) and the exact extent of the carcinoma in the breast. (Fig 12b–12d reprinted, with permission, from reference 7.)

 

View larger version (109K): [in this window] [in a new window] [Download PPT slide]   Figure 12b.  Invasive ductal carcinoma in a 44-year-old woman with a bloody nipple discharge. (a) MR ductogram (MIP image) shows no dilated duct. (b) Precontrast T1-weighted MR mammogram (MIP image) shows a high-signal-intensity structure (arrows), which represents a dilated duct. (c) Postcontrast MR mammogram (MIP image) shows an enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the relationship between the dilated ducts (green) and the carcinoma (red) and the exact extent of the carcinoma in the breast. (Fig 12b–12d reprinted, with permission, from reference 7.)

 

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 12c.  Invasive ductal carcinoma in a 44-year-old woman with a bloody nipple discharge. (a) MR ductogram (MIP image) shows no dilated duct. (b) Precontrast T1-weighted MR mammogram (MIP image) shows a high-signal-intensity structure (arrows), which represents a dilated duct. (c) Postcontrast MR mammogram (MIP image) shows an enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the relationship between the dilated ducts (green) and the carcinoma (red) and the exact extent of the carcinoma in the breast. (Fig 12b–12d reprinted, with permission, from reference 7.)

 

View larger version (84K): [in this window] [in a new window] [Download PPT slide]   Figure 12d.  Invasive ductal carcinoma in a 44-year-old woman with a bloody nipple discharge. (a) MR ductogram (MIP image) shows no dilated duct. (b) Precontrast T1-weighted MR mammogram (MIP image) shows a high-signal-intensity structure (arrows), which represents a dilated duct. (c) Postcontrast MR mammogram (MIP image) shows an enhancing area (arrows), which represents an invasive ductal carcinoma. (d) Three-dimensional fusion image shows the relationship between the dilated ducts (green) and the carcinoma (red) and the exact extent of the carcinoma in the breast. (Fig 12b–12d reprinted, with permission, from reference 7.)

 

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