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Case 12

(continued)

Answer:

This is an example of mild BPE. Mild background parenchymal enhancement corresponds to small scattered foci of enhancement.

Initial agreement studies of BPE on CEM suggest that radiologists often agree on BPE that is minimal and marked but that there is less consistent agreement with the BPE is mild and moderate. This makes sense given what we know about BPE on MRI and tissue density on mammography. There is often more agreement on the extremes.

If you use the term mild or minimal BPE, you are suggesting to the reader that the BPE should not prevent you from identifying abnormal enhancement if it is present.

If you are uncertain about whether to classify a case as mild or moderate BPE, first decide how confident you are that you will see an enhancing abnormality.
If you believe the BPE will make this harder, then classify it as moderate BPE.
If you are less concerned, then you can feel comfortable classifying it as mild.

Karimi Z, Phillips J, Slanetz P, et al. Factors Associated With Background Parenchymal Enhancement on Contrast-Enhanced Mammography. AJR Am J Roentgenol. 2021 Feb;216(2):340-348

Sogani J, Morris EA, et al. Comparison of Background Parenchymal Enhancement at Contrast-enhanced Spectral Mammography and Breast MR Imaging. Radiology. 2017 Jan;282(1):63-73

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