BIRADS Reference Card_web_F

ACR BI-RADS® Atlas Fifth Edition QUICK REFERENCE ULTRASOUND MAMMOGRAPHYTissue a. Homogeneous background echotexture – fat Breast a. The breasts are almost entirely fattycomposition b. Homogeneous background echotexture – fibroglandular composition b. There are scattered areas of fibroglandular density(screening c. Heterogeneous background echotextureonly) c. The breasts are heterogeneously dense, which may obscure small masses d. The breasts are extremely dense, which lowers the sensitivity of mammographyMasses Shape Oval Masses Shape Oval RoundCalcifications RoundAssociatedfeatures Irregular IrregularSpecial cases Orientation Parallel Margin Circumscribed Not parallel Obscured Margin Circumscribed Microlobulated Not circumscribed Indistinct - Indistinct Spiculated - Angular Density High density - Microlobulated Equal density - Spiculated Low density Anechoic Echo pattern Fat-containing Hyperechoic Calcifications Typically Skin benign Vascular Complex cystic and solid Hypoechoic Coarse or “popcorn-like” Isoechoic Large rod-like Heterogeneous Posterior features No posterior features Round Rim Enhancement Dystrophic Shadowing Milk of calcium Combined pattern Suture Calcifications in a mass Calcifications outside of a mass Suspicious Amorphous morphology Coarse heterogeneous Intraductal calcifications Fine pleomorphic Architectural distortion Fine linear or fine-linear branching Duct changes Distribution Diffuse Skin changes Skin thickening Regional Skin retraction Grouped Edema Linear Vascularity Absent Segmental Internal vascularity Architectural distortion Asymmetries Asymmetry Vessels in rim Elasticity Soft Global asymmetry assessment Intermediate Focal asymmetry Hard Developing asymmetry Simple cyst Intramammary lymph node Clustered microcysts Skin lesion Complicated cyst Solitary dilated duct Mass in or on skin Associated Skin retraction features Nipple retraction Foreign body including implants Lymph nodes – intramammary Skin thickening Lymph nodes – axillary Trabecular thickening Vascular AVMs (arteriovenous malformations/ Axillary adenopathy abnormalities pseudoaneurysms) Architectural distortion Mondor disease Location of Calcifications Postsurgical fluid collection lesion Laterality Fat necrosis Quadrant and clock face Depth Distance from the nipple For the complete Atlas, visit acr.org/birads

MAGNETIC RESONANCE IMAGINGAmount of a. Almost entirely fat Associated Nipple retractionfibroglandular b. Scattered fibroglandular tissue features Nipple invasiontissue (FGT) c. Heterogeneous fibroglandular tissueBackground d. Extreme fibroglandular tissue Skin retractionparenchymalenhancement Skin thickening(BPE)Focus Level Minimal Skin invasion Direct invasionMasses Symmetric or asymmetric Mild Inflammatory cancerNon-massenhancement Moderate Axillary adenopathy(NME) Marked Symmetric Pectoralis muscle invasion Asymmetric Chest wall invasion Architectural distortion Fat containing lesions Lymph nodes Normal Shape Oval Abnormal Margin Round Irregular Fat necrosis Internal Circumscribed enhancement Not circumscribed Hamartoma characteristics - Irregular Postoperative seroma/hematoma with fat - Spiculated Location of lesion Location Homogeneous Heterogeneous Depth Rim enhancement Dark internal septations Kinetic curve Initial phase Slow assessment Delayed phase Signal intensity Medium (SI)/time curve Fast description Persistent Plateau Washout Distribution Focal Implants Implant material and Saline Linear lumen type Silicone Segmental - Intact Regional - Ruptured Multiple regions Diffuse Other implant material Lumen type Internal Homogeneous Implant location enhancement Heterogeneous Abnormal implant - Single patterns Clumped contour - Double Intracapsular silicone - Other Clustered ring findings Retroglandular RetropectoralIntramammary lymph node Extracapsular Focal bulge siliconeSkin lesion Water droplets Radial folds Peri-implant fluid Subcapsular lineNon-enhancing Ductal precontrast high signal on T1W Keyhole sign (teardrop, noose)findings Cyst Linguine sign Postoperative collections Breast (hematoma/seroma) Lymph nodes Post-therapy skin thickening and trabecular thickening Non-enhancing mass Architectural distortion Signal void from foreign bodies, clips, etc. BI-RADS® ASSESSMENT CATEGORIESCategory 0: Mammography: Incomplete – Need Additional Imaging Evaluation and/or Prior Mammograms for Comparison Ultrasound & MRI: Incomplete – Need Additional Imaging EvaluationCategory 1: NegativeCategory 2: BenignCategory 3: Probably BenignCategory 4: Suspicious Mammography Category 4A: Low suspicion for malignancy & Ultrasound: Category 4B: Moderate suspicion for malignancy Category 4C: High suspicion for malignancyCategory 5: Highly Suggestive of MalignancyCategory 6: Known Biopsy-Proven Malignancy For the complete Atlas, visit acr.org/birads 07.15