A 45-year-old woman with BRCA1 mutation undergoes screening breast MRI. The most important indicator of malignancy on dynamic contrast-enhanced breast MRI is the type of kinetic curve pattern. Which pattern is MOST associated with malignancy?
- A Persistent (type I) — progressive enhancement over time
- B Washout (type III) — initial rise then rapid decline in enhancement ✓
- C Plateau (type II) — initial rise then flat enhancement
- D Early rapid enhancement followed by plateau
Correct answer: B. Washout (type III) — initial rise then rapid decline in enhancement
Explanation
In dynamic contrast-enhanced (DCE) breast MRI, the kinetic curve type correlates with malignancy: Type I (persistent progressive enhancement) is most commonly benign; Type II (plateau) is indeterminate; Type III (washout — rapid initial enhancement followed by rapid decline >10% by 2 minutes) is highly associated with malignancy (positive predictive value ~87%). The washout pattern reflects increased permeability and arteriovenous shunting in neoangiogenesis. This is a core BI-RADS MRI descriptor.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.