Mass Enhancement — Heterogeneous
Heterogeneous internal enhancement indicates varied, non-uniform enhancement within the mass.
Definition
There is varied, non-uniform enhancement within the mass — regions of differing signal intensity without the uniformity of homogeneous enhancement or the structured pattern of dark septations or rim enhancement.
Imaging Appearance
- Mixed areas of high and lower signal on post-contrast T1W images
- Enhancement is patchy, irregular, or uneven throughout the mass
- No organized pattern of dark septations; not rim-predominant
Suspicion Level
Heterogeneous enhancement tends to be suspicious-favoring, but both benign and malignant masses can be heterogeneous.
Examples from Source
- Irregular + spiculated + heterogeneous → IDC (very common combination)
- Lobulated + circumscribed + heterogeneous → Fibroadenoma (benign exception)
- Oval + indistinct + heterogeneous → IDC
- Irregular + indistinct + heterogeneous → IDC + abnormal axillary nodes
Clinical Significance
Heterogeneous enhancement in context of suspicious shape/margin (irregular, spiculated, indistinct) is highly concerning for malignancy. Heterogeneous enhancement in a circumscribed, oval or lobulated mass is less discriminating.