MRI-detected breast lesions: clinical implications and evaluation based on MRI/ultrasonography fusion technology


Magnetic resonance imaging (MRI) is a highly sensitive imaging modality that frequently reveals additional breast lesions that are occult on mammography and ultrasonography (US) and are thus difficult to diagnose. It is important to investigate these MRI-detected suspicious lesions, which are associated with a fairly high rate of malignancy. In this review, we have discussed MRI/US fusion technology, a magnetic position tracking system that synchronizes real-time US and MRI to improve lesion detection and enables comparisons of MRI and US findings of the detected lesions. This combination increases the precision of second-look US. We hope that our review underscores the importance of understanding the US findings and histopathology of MRI-detected breast lesions, as this will enable radiologists to perform appropriate assessments.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10


  1. 1.

    Liberman L, Morris EA, Lee MJ, Kaplan JB, LaTrenta LR, Menell JH, et al. Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 2002;179:171–8.

    Article  PubMed  Google Scholar 

  2. 2.

    Han BK, Schnall MD, Orel SG, Rosen M. Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol. 2008;191:1798–804.

    Article  PubMed  Google Scholar 

  3. 3.

    Nakano S, Yoshida M, Fujii K, Yorozuya K, Mouri Y, Kousaka J, et al. Fusion of MRI and sonography image for breast cancer evaluation using real-time virtual sonography with magnetic navigation: first experience. Jpn J Clin Oncol. 2009;39:552–9.

    Article  PubMed  Google Scholar 

  4. 4.

    Pons EP, Azcon FM, Casas MC, Meca SM, Espona JLG. Real-time MRI navigated US: role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. Eur J Radiol. 2014;83:942–50.

    Article  PubMed  Google Scholar 

  5. 5.

    Uematsu T, Takahashi K, Nishimura S, Watanabe J, Yamasaki S, Sugino T, et al. Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone. Eur Radiol. 2016;26:1064–72.

    Article  PubMed  Google Scholar 

  6. 6.

    Watanabe R, Ando T, Osawa M, Ido M, Kousaka J, Mouri Y, et al. Second-look US using real-time virtual sonography, a coordinated breast US and MRI system with electromagnetic tracking technology: a pilot study. Ultrasound Med Biol. 2017;43:2362–71.

    Article  PubMed  Google Scholar 

  7. 7.

    Uematsu T. Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI. Jpn J Radiol. 2013;31:826–31.

    Article  PubMed  Google Scholar 

  8. 8.

    Fausto A, Bernini M, La Forgia D, Fanizzi A, Marcasciano M, Volterrani L, et al. Six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions. Eur Radiol. 2019;29:1799–808.

    Article  PubMed  Google Scholar 

  9. 9.

    Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.

    Article  PubMed  Google Scholar 

  10. 10.

    Pediconi F, Catalano C, Roselli A, Padula S, Altomari F, Moriconi E, et al. Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions. Radiology. 2007;243:670–80.

    Article  PubMed  Google Scholar 

  11. 11.

    Spick C, Baltzer PA. Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 2014;273:401–9.

    Article  PubMed  Google Scholar 

  12. 12.

    Tozaki M, Yamashiro N, Sakamoto M, Sakamoto N, Mizuuchi N, Fukuma E. Magnetic resonance-guided vacuum-assisted breast biopsy: results in 100 Japanese women. Jpn J Radiol. 2010;28:527–33.

    Article  PubMed  Google Scholar 

  13. 13.

    Abe H, Schmidt RA, Shah RN, Shimauchi A, Kulkarni K, Sennett CA, et al. MR-directed ("Second-Look") ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol. 2010;194:370–7.

    Article  PubMed  Google Scholar 

  14. 14.

    Demartini WB, Eby PR, Peacock S, Lehman CD. Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol. 2009;192:1128–34.

    Article  PubMed  Google Scholar 

  15. 15.

    LaTrenta LR, Menell JH, Morris EA, Abramson AF, Dershaw DD, Liberman L. Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology. 2003;227:856–61.

    Article  PubMed  Google Scholar 

  16. 16.

    Meissnitzer M, Dershaw DD, Lee CH, Morris EA. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 2009;193:1025–9.

    Article  PubMed  Google Scholar 

  17. 17.

    Dratwa C, Jalaguier-Coudray A, Thomassin-Piana J, Gonin J, Chopier J, Antoine M, et al. Breast MR biopsy: pathological and radiological correlation. Eur Radiol. 2016;26:2510–9.

    Article  PubMed  Google Scholar 

  18. 18.

    D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA. ACR BI-RADS Atlas, breast imaging reporting and data system. 5th ed. Reston, VA: American College of Radiology; 2013.

    Google Scholar 

  19. 19.

    Spick C, Schernthaner M, Pinker K, Kapetas P, Bernathova M, Polanec SH, et al. MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience. Eur Radiol. 2016;26:3908–16.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Sung JS, Lee CH, Morris EA, Comstock CE, Dershaw DD. Patient follow-up after concordant histologically benign imaging-guided biopsy of MRI-detected lesions. AJR Am J Roentgenol. 2012;198:1464–9.

    Article  PubMed  Google Scholar 

  21. 21.

    Li J, Dershaw DD, Lee CH, Kaplan J, Morris EA. MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy. AJR Am J Roentgenol. 2009;193:850–5.

    Article  PubMed  Google Scholar 

  22. 22.

    Shaylor SD, Heller SL, Melsaether AN, Gupta D, Gupta A, Babb J, et al. Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy—is it worthwhile? Eur Radiol. 2014;24:1176–85.

    Article  PubMed  Google Scholar 

  23. 23.

    Clauser P, Mann R, Athanasiou A, Prosch H, Pinker K, Dietzel M, et al. A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice. Eur Radiol. 2018;28:1909–18.

    Article  PubMed  Google Scholar 

  24. 24.

    Nakano S, Kousaka J, Fujii K, Yorozuya K, Yoshida M, Mouri Y, et al. Impact of real-time virtual sonography, a coordinated sonography and MRI system that uses an image fusion technique, on the sonographic evaluation of MRI-detected lesions of the breast in second-look sonography. Breast Cancer Res Treat. 2012;134:1179–88.

    Article  PubMed  Google Scholar 

  25. 25.

    Tatsugami F, Matsuki M, Nakai G, Tanikake M, Yoshikawa S, Narabayashi I, et al. Hepatic computed tomography for simultaneous depiction of hepatocellular carcinoma, intrahepatic portal veins, and hepatic veins in real-time virtual sonography: initial experience. J Ultrasound Med. 2007;26:1065–9.

    Article  PubMed  Google Scholar 

  26. 26.

    Kawasoe H, Eguchi Y, Mizuta T, Yasutake T, Ozaki I, Shimonishi T, et al. Radiofrequency ablation with the real-time virtual sonography system for treating hepatocellular carcinoma difficult to detect by ultrasonography. J Clin Biochem Nutr. 2007;40:66–72.

    Article  PubMed  Google Scholar 

  27. 27.

    Ando T, Ito Y, Ido M, Osawa M, Kousaka J, Mouri Y, et al. Pre-operative planning using real-time virtual sonography, an MRI/ultrasound image fusion technique, for breast-conserving surgery in patients with non-mass enhancement on breast MRI: a preliminary study. Ultrasound Med Biol. 2018;44:1364–70.

    Article  PubMed  Google Scholar 

  28. 28.

    Park AY, Seo BK, Han H, Cho KR, Woo OH, Cha SH, et al. Clinical value of real-time ultrasonography-MRI fusion imaging for second-look examination in preoperative breast cancer patients: additional lesion detection and treatment planning. Clin Breast Cancer. 2018;18:261–9.

    Article  PubMed  Google Scholar 

  29. 29.

    Kang DK, Jung Y, Han S, Kim JY, Kim TH. Clinical utility of real-time MR-navigated ultrasound with supine breast MRI for suspicious enhancing lesions not identified on second-look ultrasound. Ultrasound Med Biol. 2017;43:412–20.

    Article  PubMed  Google Scholar 

  30. 30.

    Kucukkaya F, Aribal E, Tureli D, Altas H, Kaya H. Use of a volume navigation technique for combining real-time ultrasound and contrast-enhanced MRI: accuracy and feasibility of a novel technique for locating breast lesions. AJR Am J Roentgenol. 2016;206:217–25.

    Article  PubMed  Google Scholar 

  31. 31.

    Uematsu T. How to choose needles and probes for ultrasonographically guided percutaneous breast biopsy: a systematic approach. Breast Cancer. 2012;19:238–41.

    Article  PubMed  Google Scholar 

Download references


This paper was presented at the 104th annual meeting of the Radiological Society of North America in Chicago, 2018, where it received a Cum Laude award as an education exhibit. We thank Enago ( for the English language review.

Author information



Corresponding author

Correspondence to Kazuaki Nakashima.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nakashima, K., Uematsu, T., Harada, T.L. et al. MRI-detected breast lesions: clinical implications and evaluation based on MRI/ultrasonography fusion technology. Jpn J Radiol 37, 685–693 (2019).

Download citation


  • Breast cancer
  • MRI-detected lesion
  • Second-look ultrasonography
  • Fusion
  • Real-time virtual sonography