الفهرس 
Introduction and aim of work
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Abstract
This study aims at highlighting the role of dynamic post contrast MRI, morphological & functional MRI in characterization of breast cancer. The study included 34 women patients who had breast lesions with mammographic BIRADS categories 3 - 4, or who had high risk for breast cancer or had history of resected malignant breast lesion with suspicion of malignancy in the same or the other breast. In addition to the routine plain MRI sequences, all cases had dynamic post contrast MRI and MRI diffusion studies. On histo-pathological examination of biopsies or resected lesions, 18 patients had benign lesions with 8 of them having fibro-cystic change. Sixteen patients had malignant breast tumors with 14 of them infiltrating duct carcinomas. On morphological analysis, 8 lesions had smooth margins, all the eight lesions were benign. Ten lesions had spiculated margins, 8 of them were malignant. Three lesions enhanced less than the breast tissue, all the three lesions were benign. Nine lesions had rim enhancement, 7 of them were malignant. On dynamic study, fast enhancement (wash-in rates of ≥ 90 %) was found in 12 out of 16 malignant lesions. Rapid uptake followed by rapid wash out (type 3 curve) was encountered in 13 out of 16 malignant lesions. Continuous uptake (type 1 curve) was found in 12 out of 18 benign lesions. Two cases (one malignant and one benign lesion) had rapid uptake and plateau (type 2 curve) and considered borderline. On DWI, 15 out of 16 malignant lesions had restricted diffusion with ADC < 1.6 X 10-3 mm2 /s and 16 out of 18 benign lesions had free diffusion. On MRS, two out of the studied 4 cases showed positive Choline peak and both were positive for malignancy on histopathology. Using dynamic study and time intensity curve allowed the detection of 13 out of 16 malignant lesions and 12 out of 18 benign lesions, with MR sensitivity of 81 % and specificity of 67 %. Combining morphological and kinetic features increased the MR sensitivity to 87 % and specificity to 85 %. When DWI was added, MRI sensitivity became 94 % and its specificity raised to 89 %. In conclusion, the combination of morphological MRI pattern, dynamic MRI and diffusion MRI studies improves sensitivity and specificity of MRI in detecting breast malignancy. Recommendation: When question of benignity versus malignancy is raised, the combined morphological, dynamic and functional MRI studies provide the best investigating tool. So, lesions with mammographic BIRADS categories 3-4 have to be studied with these three MRI techniques in combination.