Spectrum of Clustered Ring Enhancement (CRE) on Breast MRI: Malignancies and their Mimics

Clustered ring enhancement (CRE) was recently added to the 5th edition of the BI-RADS Atlas as one of four internal enhancement patterns (IEP). We are challenged to clarify this distinction in practice.  Dr. Chikarmane describes her systematic approach to these related phenomena.  She shares her insight and experience, tempered by the literature, by using select practical illustrations intended to show key distinctions among findings. ~objectives~ Upon completion of this activity, participants should be able to: Understand ACR BI-RADS definition of CRE. Differentiate CRE from the other BI-RADS descriptors of internal enhancement. Describe proposed pathophisiology of CRE using radiology-pathology correlation. Assess examples of malignant vs. benign etiologies of CRE. Evaluate practical approaches to breast intervention for adaptation to local practice.