Adjacent vessel sign and breast imaging reporting and data system are valuable for diagnosis of benign and malignant breast lesions

The purpose of this study is to investigate whether an adjacent vessel sign (AVS) observed on the maximum intensity projections (MIPs) from the subtracted images can help distinguish between malignant and benign breast lesions and to test whether the combination of breast imaging reporting and data system (BI-RADS) category and AVS can increase the specificity and diagnostic accuracy of breast magnetic resonance imaging (MRI). The study included 63 histologically verified lesions which underwent dynamic breast MRI before biopsy. All magnetic resonance (MR) images were evaluated by two radiologists in consensus, who were unaware of the histopathological outcome. The MR images of all cases were analyzed according to BI-RADS-MRI assessment category. Levels of suspicion were reported as categories of I-V. The presence of vessels either entering the enhancing lesion or in contact with the lesion edge on MIP images was considered as the presence of AVS. Final analysis of 63 masses revealed 41 malignant lesions (65.1%) and 22 benign lesions (34.9%). Thirty seven out of 41 malignant lesions and 3 out of 22 benign lesions were associated with adjacent vessel, with highly significant difference between benign and malignant lesions (P < 0.001), especially for lesions smaller than 2.0 cm. The corresponding specificity, sensitivity and accuracy of contrast-enhanced 3.0-T breast were 86.4%, 82.9% and 84.1%, respectively. Based on BI-RADS-MRI category, the specificity, sensitivity and accuracy of breast MRI were 54.5%, 100% and 84.1%, respectively. After combining BI-RADS category and AVS, the specificity, sensitivity and accuracy of breast MRI were 90.9%, 82.9% and 85.7%, respectively. AVS can help differentiate malignant from benign breast lesions, especially for the lesions smaller than 2.0 cm. The combination of BI-RADS category and AVS can increase the specificity and the diagnostic accuracy of breast MRI.