NME Enhancement — Clumped
Clumped internal NME enhancement indicates enhancement that is grouped into cobblestone-like clumps — discrete enhancing foci aggregated together within the NME region.
Definition
Enhancement grouped into discrete cobblestone-like masses or clumps, with non-enhancing tissue between the groups. The clumps are of varying sizes.
Imaging Appearance
- Early post-contrast T1W: discrete rounded or irregular foci of enhancement grouped together
- Non-enhancing tissue (fat, fibroglandular) separates the clumps
- Appearance resembles “cobblestones” or a cluster of grapes
- Differs from clustered ring in that clumped = solid-appearing foci, not ring-shaped
Suspicion Level
Clumped enhancement is suspicious-favoring, particularly when combined with segmental, linear, or regional distribution.
Board Pearl
Clumped enhancement in a segmental or linear distribution is highly suspicious for DCIS. This combination should prompt biopsy (BI-RADS 4 or higher).
Examples from Source
- Regional, clumped NME → DCIS with microinvasion
- Focal, clumped NME → Fibrocystic change (benign)
- Focal, clumped NME → DCIS (malignant)
- Focal, clumped NME → IDC and DCIS (malignant)
- Linear, clumped NME → DCIS
- Linear, clumped NME → LCIS
- Segmental, clumped NME → DCIS
Clumped vs Clustered Ring
| Feature | Clumped | Clustered Ring |
|---|---|---|
| Appearance | Solid cobblestone foci | Ring-shaped foci |
| Central enhancement | Yes (solid) | No (hollow ring) |
| Typical association | DCIS, fibrocystic | DCIS (higher grade), IDC |