Breast Magnetic Resonance Imaging as a Problem-Solving Tool in Patients with Mammographic Architectural Distortion

Architectural distortion detected on full-field digital mammography represents a significant diagnostic challenge due to its association with both benign and malignant pathologies. This retrospective study evaluated the diagnostic performance of breast magnetic resonance imaging (MRI) in differentiating benign and malignant lesions in patients with mammographic architectural distortion. Sixty-two patients (age range, 27–78 years; median, 48 years) examined between January 2020 and March 2021 were included. Histopathological confirmation was available for 36 lesions, while 26 benign lesions were validated by at least two years of imaging follow-up. MRI features analyzed included lesion type, margin characteristics, internal enhancement pattern, background parenchymal enhancement, T2 signal intensity, diffusion restriction, apparent diffusion coefficient (ADC) values, and kinetic curve type. Of the evaluated lesions, 17 were malignant and 19 were benign. Malignancy was significantly associated with non-circumscribed margins, heterogeneous or rim enhancement, diffusion restriction, low ADC values, and wash-out kinetic patterns, whereas benign lesions were more frequently characterized by high T2 signal intensity and homogeneous enhancement (all p < 0.05). Minimal background parenchymal enhancement was more common in malignant cases, while marked enhancement was observed exclusively in benign lesions. MRI showed limited ability to reliably differentiate radial scars from invasive carcinoma. Overall, breast MRI provided additional diagnostic value in the evaluation of mammographic architectural distortion. A multiparametric approach integrating morphologic, functional, and dynamic MRI features improved diagnostic accuracy and may help reduce unnecessary biopsies, while highlighting key imaging predictors of malignancy.