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Figure 2a. Images obtained in a 54-year-old-woman with synchronous, bilateral carcinoma of the breast. (a) Conventional craniocaudal mammograms show two neighboring masses (arrow) with partially ill-defined and partially spiculated margins in the medial part of the left breast (BI-RADS category 5). (b) Transverse maximum intensity projection, subtraction, contrast-enhanced, T1-weighted, FLASH MR image (336/5, 90° flip angle) of the breasts shows hypervascular lesions (large arrow) in the left breast that correspond to the mammographic findings. In addition, a small hypervascularized lesion (small arrow) is detectable in the central part of the right breast. This lesion was not visible with conventional mammography or US. MR-guided preoperative hook wire localization of the suspicious lesion seen with MR imaging alone in the right breast was performed 5 days after b was obtained. (c) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained with the patient in the supine position and with a stereotactic unit placed on the right breast before the administration of contrast material shows hypointense parenchyma (arrows) in the central part of the right breast. (d) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained 2 minutes after the intravenous administration of gadopentetate dimeglumine demonstrates the hypervascular lesion (arrow) within the parenchyma. (e) Transverse, T1-weighted, two-dimensional, spin-echo MR image (100/5, 90° flip angle) obtained after the insertion of a nonmagnetic hook wire demonstrates the correct position of the wire tip (arrow) within the lesion. Histopathologic analysis revealed a multifocal invasive ductal carcinoma (pT2) of the left breast and a 7-mm invasive ductal carcinoma (pT1) of the right breast.