Breast a. The breasts are almost entirely fatty Tissue composition a. Homogeneous background echotexture – fat Amount of a. Almost entirely fat Associated features Nipple retraction composition (screening only) fibroglandular b. Scattered fibroglandular tissue Nipple invasion b. There are scattered areas of fibroglandular density b. Homogeneous background echotexture – fibroglandular tissue (FGT) c. Heterogeneous fibroglandular tissue c. The breasts are heterogeneously dense, which c. Heterogeneous background echotexture Skin retraction d. Extreme fibroglandular tissue Skin thickening may obscure small masses d. The breasts are extremely dense, which lowers Background Level Minimal Skin invasion Direct invasion the sensitivity of mammography parenchymal Mild Inflammatory cancer enhancement Moderate Axillary adenopathy Masses Shape Oval Masses Shape Oval (BPE) Marked Pectoralis muscle invasion Round Round Symmetric or Symmetric Chest wall invasion Irregular Irregular asymmetric Asymmetric Architectural distortion Margin Circumscribed Orientation Parallel Focus Fat containing lesions Lymph nodes Normal Obscured Not parallel Masses Shape Oval Abnormal Microlobulated Margin Circumscribed Round Fat necrosis Indistinct Not circumscribed Irregular Hamartoma Spiculated - Indistinct Margin Circumscribed Postoperative seroma/hematoma with fat Density High density - Angular Not circumscribed Location of lesion Location Equal density - Microlobulated - Irregular Depth Low density - Spiculated - Spiculated Kinetic curve Initial phase Slow Fat-containing Echo pattern Anechoic Internal Homogeneous assessment Medium enhancement Signal intensity (SI)/ Calcifications Typically benign Skin Hyperechoic Heterogeneous Fast characteristics time curve description Vascular Complex cystic and solid Rim enhancement Delayed phase Persistent Coarse or “popcorn-like” Hypoechoic Dark internal septations Plateau Large rod-like Isoechoic Washout Round Heterogeneous Non-mass Distribution Focal Implants Implant material and Saline Rim Posterior No posterior features enhancement Linear lumen type Silicone features (NME) Segmental - Intact Dystrophic Enhancement Regional - Ruptured Milk of calcium Shadowing Multiple regions Other implant material Suture Combined pattern Diffuse Lumen type Suspicious Amorphous Calcifications Calcifications in a mass morphology - Single Coarse heterogeneous Calcifications outside of a mass - Double Fine pleomorphic Intraductal calcifications - Other Fine linear or fine-linear branching Associated Architectural distortion Internal Homogeneous Implant location Retroglandular features enhancement Heterogeneous Retropectoral Distribution Diffuse Duct changes patterns Regional Skin changes Skin thickening Clumped Abnormal implant Focal bulge Clustered ring contour Grouped Skin retraction Intramammary lymph node Intracapsular silicone Radial folds Linear Edema findings Skin lesion Subcapsular line Segmental Vascularity Absent Non-enhancing Ductal precontrast high signal on T1W Keyhole sign (teardrop, noose) Architectural distortion Internal vascularity findings Cyst Linguine sign Asymmetries Asymmetry Vessels in rim Postoperative collections (hematoma/seroma) Extracapsular silicone Breast Global asymmetry Elasticity Soft assessment Post-therapy skin thickening and trabecular Lymph nodes Focal asymmetry Intermediate thickening Water droplets Developing asymmetry Hard Peri-implant fluid Non-enhancing mass Intramammary lymph node Special cases Simple cyst Architectural distortion Skin lesion Clustered microcysts Signal void from foreign bodies, clips, etc. Solitary dilated duct Complicated cyst Associated Skin retraction Mass in or on skin features Nipple retraction Foreign body including implants BI-RADS® ASSESSMENT CATEGORIES Skin thickening Lymph nodes – intramammary Category 0: Mammography: Incomplete – Need Additional Imaging Evaluation and/or Prior Mammograms for Comparison Trabecular thickening Lymph nodes – axillary Ultrasound & MRI: Incomplete – Need Additional Imaging Evaluation Axillary adenopathy Vascular AVMs (arteriovenous malformations/ Category 1: Negative Architectural distortion abnormalities pseudoaneurysms) Category 2: Benign Calcifications Mondor disease Category 3: Probably Benign Location of lesion Laterality Postsurgical fluid collection Category 4: Suspicious Category 4A: Low suspicion for malignancy Mammography Category 4B: Moderate suspicion for malignancy Quadrant and clock face Fat necrosis & Ultrasound: Category 4C: High suspicion for malignancy Depth Category 5: Highly Suggestive of Malignancy Distance from the nipple Category 6: Known Biopsy-Proven Malignancy
For the complete Atlas, visit acr.org/birads 07.15