Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation

Fat necrosis of the breast is a challenging diagnosis due to the various appearances on mammography, ultrasound, CT, PET-CT, and MRI. Although mammography is more specific, ultrasound is a very important tool in making the diagnosis of fat necrosis. MRI has a wide spectrum of findings for fat necrosis and the appearance is the result of the amount of the inflammatory reaction, the amount of liquefied fat, and the degree of fibrosis. While CT and PET-CT are not first line imaging examinations for the diagnosis of breast cancer or fat necrosis, they are frequently performed in the surveillance and staging of disease. Knowledge of how fat necrosis presents on these additional imaging techniques is important to prevent misinterpretation of the imaging findings. Gross and microscopic appearances of fat necrosis depend on the age of the lesion; the histologic examination of fat necrosis is usually straightforward. Knowledge of the variable appearances of fat necrosis on a vast array of imaging modalities will enhance a radiologist's accuracy in the analysis and interpretation of fat necrosis versus other diagnoses.