On breast MRI for high-risk screening, a 0.8 cm focus shows a type III kinetic curve (rapid initial enhancement followed by washout) and irregular morphology. What does the type III kinetic pattern indicate?

• A Benign finding — persistent enhancement plateau
• B Indeterminate — neither benign nor malignant
• C Artefact — motion during dynamic acquisition
• D Suspicious — washout kinetics correlate with malignancy ✓

Explanation

On dynamic contrast-enhanced breast MRI, kinetic curves are classified as type I (persistent progressive enhancement — benign), type II (plateau — indeterminate), and type III (washout after initial rapid rise — suspicious for malignancy). Type III kinetics with irregular morphology carries the highest positive predictive value for invasive breast cancer. The washout pattern reflects dense tumour vascularity with arteriovenous shunting, a feature of malignant neovascularity.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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