RadVault

RadVault Index

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RadVault Knowledge Base Index

Technique (3 pages)

PageDescription
Dynamic Contrast Enhanced MRIFoundation of breast MRI; DCE principles, timing, fat removal
Abbreviated MRIShort protocol (<10 min); screening applications
Diffusion Weighted ImagingNon-contrast DWI; ADC; not yet formal BI-RADS

Overviews (1 page)

PageDescription
Breast MRI Lexicon OverviewMaster map-of-content; v2025 changes summary; benign combination rule

Findings (8 pages)

PageDescription
Fibroglandular TissueFGT categories; MRI vs mammographic density distinction
Background Parenchymal EnhancementBPE definition, levels, symmetry, clinical significance
MassesMass definition; all descriptor categories; <2% rule; v2025 changes
Non-Mass EnhancementNME definition; distribution and internal enhancement pattern categories
Lymph NodesIntramammary, axillary, internal mammary; normal vs abnormal; v2025 separate category
Associated Features8 features: nipple, skin, pectoralis, chest wall, peritumoral edema
Other Findings Typically Benign9 benign findings: cysts, fat necrosis, hamartoma, etc.
Implants and AugmentationLocation, material, integrity, rupture signs, BIA-ALCL

Descriptors — FGT (4 pages)

PageDescription
FGT — Almost Entirely FattyCategory A
FGT — Scattered Fibroglandular TissueCategory B
FGT — Heterogeneous Fibroglandular TissueCategory C
FGT — Extreme Fibroglandular TissueCategory D

Descriptors — BPE (4 pages)

PageDescription
BPE — MinimalIncludes no enhancement
BPE — MildSmall amount of parenchymal enhancement
BPE — ModerateSubstantial parenchymal enhancement
BPE — MarkedExtensive parenchymal enhancement

Descriptors — Mass Shape (4 pages)

PageDescription
Mass Shape — OvalElliptical, no undulations; benign-favoring
Mass Shape — LobulatedOne or more indentations; v2025: reintroduced separate category
Mass Shape — RoundSpherical, equal diameters
Mass Shape — IrregularAcute-angle protrusions; most suspicious shape

Descriptors — Mass Margin (3 pages)

PageDescription
Mass Margin — CircumscribedEntire margin smooth/sharp; strict MRI definition
Mass Margin — IndistinctUneven, non-spiculated; v2025: replaces “irregular margin”
Mass Margin — SpiculatedRadiating lines; most suspicious margin

Descriptors — Mass Internal Enhancement (4 pages)

PageDescription
Mass Enhancement — HomogeneousConfluent uniform enhancement
Mass Enhancement — Dark Internal SeptationsNon-enhancing lines; fibroadenoma-suggestive
Mass Enhancement — HeterogeneousVaried, non-uniform enhancement
Mass Enhancement — Thick Rim EnhancementPeripheral thick rim; v2025: renamed from “rim enhancement”

Descriptors — Mass T2 Signal (2 pages)

PageDescription
Mass T2 Signal — HyperintenseLymph node bright; key benign-combination feature
Mass T2 Signal — Not HyperintenseNot lymph node bright; most carcinomas

Descriptors — Enhancement Kinetics (1 page)

PageDescription
Enhancement KineticsEarly phase (slow/medium/fast); delayed phase (persistent/plateau/washout)

Descriptors — NME Distribution (5 pages)

PageDescription
NME Distribution — Diffuse2+ quadrants; can be malignant
NME Distribution — Regional>1 quadrant, not diffuse, not ductal
NME Distribution — Focal<1 quadrant, not segmental/linear; least suspicious
NME Distribution — LinearLine/branch pattern; suspicious — ductal
NME Distribution — SegmentalCone/triangle, apex toward nipple; suspicious — ductal/segmental

Descriptors — NME Internal Enhancement (4 pages)

PageDescription
NME Enhancement — HomogeneousUniform NME enhancement
NME Enhancement — HeterogeneousVaried NME enhancement
NME Enhancement — ClumpedCobblestone-like grouped foci; suspicious
NME Enhancement — Clustered RingClustered hollow ring foci; suspicious; high-grade DCIS

Descriptors — Lymph Nodes (3 pages)

PageDescription
Lymph Node — IntramammaryWithin breast; no size threshold; compare to priors
Lymph Node — AxillaryLevels I-III; subjective asymmetry key; 3 mm rule NOT applicable
Lymph Node — Internal MammaryNormal up to 9-10 mm in screening; >=5 mm suspicious with cancer

Descriptors — Associated Features (8 pages)

PageDescription
Associated Feature — Nipple RetractionPulled in; distinguish from inversion
Associated Feature — Nipple InvolvementMalignant enhancement contiguous with nipple; Paget disease
Associated Feature — Skin RetractionSkin pulled in; benign if stable/post-surgical
Associated Feature — Skin Thickening> 2 mm; focal or diffuse
Associated Feature — Skin InvolvementDefinitive skin enhancement; staging T4b/T4d
Associated Feature — Pectoralis Muscle InvolvementNOT chest wall; distinct staging
Associated Feature — Chest Wall InvolvementIntercostal/serratus/ribs = T4a
Associated Feature — Peritumoral Edemav2025 new; T2 bright around tumor; LN metastases risk

Descriptors — Other Findings Typically Benign (9 pages)

PageDescription
Other Finding — High T1 Duct SignalBlood/protein in ducts; benign without ductal enhancement
Other Finding — CystsT2 bright; thin peri-cystic enhancement is benign
Other Finding — Postoperative CollectionsHematoma/seroma; thin peripheral enhancement benign
Other Finding — Post-Therapy Skin and Trabecular ThickeningAfter surgery/radiation
Other Finding — Non-Enhancing MassBenign solid mass (exception: post-NAC malignancy)
Other Finding — Signal VoidMetallic clip/foreign body artifact
Other Finding — Fat NecrosisInternal fat signal diagnostic; variable enhancement
Other Finding — HamartomaFat + FGT in pseudocapsule; enhanced FGT = benign
Other Finding — Enhancing Skin LesionsMoles, keloids; usually not reported

Descriptors — Implants (5 pages)

PageDescription
Implant — Radial FoldsNormal infolding; NOT rupture
Implant — Subcapsular Line SignIntracapsular rupture
Implant — Keyhole SignIntracapsular rupture; silicone in radial fold
Implant — Linguine SignAdvanced intracapsular rupture; pathognomonic
Implant — Water DropletsCan occur in intact or ruptured implants

Assessment (1 page)

PageDescription
BI-RADS Assessment CategoriesCategories 0-6; management; hierarchy 5>4>0>6>3>2/1; v2025 changes

Guidance (2 pages)

PageDescription
MRI Report Organization8 required components; structured indications (v2025 new)
v2025 Major UpdatesSummary of all lexicon, reporting, and guidance changes

Location (1 page)

PageDescription
Location of FindingClock face, depth, distance from nipple; whole numbers only

DDx Pages (5 pages)

PageDescription
Thick Rim Enhancement DDxIDC vs abscess vs fat necrosis
T2 Hyperintense Mass DDxFibroadenoma vs mucinous carcinoma vs cyst
NME Distribution DDxDifferential by distribution type; distribution x pattern matrix
Oval Circumscribed Mass DDxFibroadenoma vs lymph node vs mucinous carcinoma
Breast Imaging Differential DiagnosesComprehensive multimodality DDx — calcs, masses, AD, NME, LN, BI-RADS 5 mimics

Breast Imaging — Technique (9 pages)

PageDescription
Breast Cancer StagingTNM AJCC 8th; T/N/M categories; 5-year survival; multifocal vs multicentric
Breast Cancer TreatmentSLNB, radiation, systemic therapy, margins, anticoagulation
Post-Operative BreastLumpectomy changes, RT timeline, recurrence detection
Breast ReconstructionTRAM vs DIEP, pedicled vs free flaps, ADM
Breast Implants — MultimodalityImplant types, rupture signs all modalities, BIA-ALCL, FDA guidelines
Biopsy TechniqueUS/stereotactic/MRI-guided biopsy, clips, anticoagulation
Breast MRI Extra-Mammary FindingsDistant mets, lymph nodes, chest wall, staging
Breast Ultrasound TechniqueScreening, ACRIN 6666, malignant features, spatial compound
Key Clinical TrialsZ0011, Z1071, ACRIN 6666, Choosing Wisely

Breast Imaging — Special Populations (2 pages)

PageDescription
Pregnancy and Lactation ImagingRadiation safety, gadolinium, SLNB, rusty pipe syndrome, pediatric
Artificial Intelligence in Breast ImagingAI concepts, performance, patient acceptance

Breast Imaging — Findings (2 pages)

PageDescription
BIA-ALCLBIA-ALCL pathogenesis, imaging, staging, treatment, prognosis

Page Count Summary

CategoryCount
Technique (MRI)3
Technique (Breast Imaging)9
Special Populations2
Overview1
Finding9
Descriptor56
Assessment1
Guidance2
Location1
DDx5
Total89

Rectal Cancer — Technique (1 page)

PageDescription
High Resolution Rectal MRIMRI technique for rectal cancer staging; structured reporting

Rectal Cancer — Overviews (1 page)

PageDescription
Rectal Cancer Staging OverviewMaster map-of-content; 8 key controversies; evolving treatment paradigm

Rectal Cancer — Findings (3 pages)

PageDescription
Rectal Anatomy for StagingAnal canal definitions; rectum definition; vascular/lymphatic drainage
Mesorectal FasciaMRF anatomy; involvement criteria; 1 mm cutoff; MRI performance
Circumferential Resection MarginCRM vs MRF distinction; surgical variability

Rectal Cancer — Descriptors (7 pages)

PageDescription
Anterior Peritoneal ReflectionAPR seagull sign; upper vs lower rectum; peritoneal investment
Sigmoid TakeoffSTO imaging landmark; validation; pitfalls
Rectal Cancer T StagingAJCC 8th edition T stages; sphincter controversy; MRF and T stage
Extramural Vascular InvasionEMVI MRI appearance; prognostic significance; MRF involvement
Tumor DepositsDefinition; comet tail sign; distinction from lymph nodes
Lateral Pelvic Lymph NodesLPLN compartments; size criteria; pre/post-nCRT thresholds
Sphincter ComplexInternal/external sphincter; puborectalis; surgical anal canal

Rectal Cancer — Guidance (1 page)

PageDescription
Rectal Cancer Neoadjuvant Therapy DecisionUpper vs lower rectum management; anatomy over stage paradigm

Page Count Summary

CategoryCount
Technique4
Overview2
Finding11
Descriptor63
Assessment1
Guidance3
Location1
DDx4
Total89

Last updated: 2026-04-14 — All of Breast Imaging (1).pdf ingest (88 pages, 13 new wiki pages, 93 new cards)

RECIST — Assessment (1 page)

PageDescription
RECIST 1.1 OverviewMaster assessment page; CR/PR/SD/PD; master response table; endpoints

RECIST — Descriptors (5 pages)

PageDescription
Measurable DiseaseMeasurable vs non-measurable; thresholds; nodal size cutoffs
Target LesionsSelection (max 5/2 per org); sum of diameters; tracking rules
Non-target LesionsQualitative tracking; unequivocal progression; non-target-only patients
New LesionsUnequivocal standard; PET rules; unscanned locations; reappearance rule
Nadir ConceptNadir vs baseline; PD calculation; continuing PR

RECIST — Comparison (1 page)

PageDescription
RECIST v1.0 vs v1.1All 7 major changes between versions

RECIST — Guidance (1 page)

PageDescription
Alternative Response CriteriaChoi (GIST), iRECIST (immunotherapy), mRECIST (HCC), Lugano (lymphoma)

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