Lesion-mimicking DIXON swap artifact in contrast-enhanced subtraction breast MRI

Breast cancer is the most common cancer in women; approximately 1 in 8 women is diagnosed with breast cancer in their lifetime. Some women are at significantly higher risk of developing breast cancer, including women carrying mutations in the BRCA1/2, TP53, or other genes and women with other risk factors. Women with a high lifetime risk for breast cancer are frequently offered annual breast magnetic resonance imaging (MRI) examinations for early breast cancer detection. Breast MRI is commonly performed using a multiparametric imaging protocol, including dynamic contrast-enhanced T1-weighted acquisitions. The dynamic contrast-enhanced T1-weighted acquisitions are frequently transformed into subtraction series, allowing the focused visualization of areas with high signal intensity and masses associated with elevated contrast agent uptake, which are among the hallmarks of suspicious findings. Here, we report a case in which a suspicious lesion-mimicking swap artifact occurred using a T1-weighted contrast-enhanced DIXON acquisition technique in a high-risk breast cancer screening MRI examination.