Breast Cancer With Renal and Adrenal Metastases: CT and MRI Imaging Features, Renal Vein Thrombosis, Differential Diagnosis, and Treatment

 

Author: Dr. Elias Lee

Abstract

Renal and adrenal masses discovered during breast cancer staging present a diagnostic challenge because metastatic disease may resemble primary renal malignancy or benign adrenal lesions. Although the kidneys and adrenal glands are recognized sites of secondary malignancy, renal metastases from breast cancer are uncommon in routine clinical practice and may remain clinically silent until cross-sectional imaging is performed.

This case describes a woman in her 60s undergoing MRI for breast cancer staging. Imaging demonstrates a lobulated right adrenal mass, a large right renal hilar mass displacing adjacent vessels, a separate small posterior cortical mass in the right lower renal pole, and a small renal vein thrombus. The lesions show heterogeneous enhancement and suspicious diffusion characteristics. No suspicious hepatic metastasis is identified in the described examination.

The principal diagnostic considerations include metastatic breast cancer, primary renal cell carcinoma (RCC), adrenal adenoma, adrenocortical carcinoma, lymphoma, and bland versus tumor thrombus. Accurate interpretation requires correlation of multiphasic contrast-enhanced imaging, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, prior examinations, systemic staging, and tumor biology. Histopathological confirmation should be considered when the diagnosis remains uncertain and would change management.

This article reviews the pathophysiology, epidemiology, clinical presentation, imaging findings, differential diagnosis, diagnostic workup, treatment principles, and prognostic considerations of breast cancer with suspected renal and adrenal metastases.

1. Introduction

Breast cancer staging requires more than evaluating the primary breast lesion and regional lymph nodes. Identifying distant metastases is essential because metastatic disease changes treatment objectives, influences systemic therapy selection, and may alter the role of surgery and local treatment.

The most frequently recognized distant metastatic sites include bone, lung, liver, and brain. Renal and adrenal lesions are less typical and can be diagnostically challenging, particularly when they are discovered incidentally in patients with a known malignancy.

A renal mass in a patient with breast cancer should not automatically be classified as a metastasis. Primary RCC may coexist with breast cancer, and the two conditions can demonstrate overlapping imaging features. Similarly, an adrenal mass may represent metastatic disease, a lipid-rich or lipid-poor adenoma, pheochromocytoma, or adrenocortical carcinoma.

The present case illustrates the importance of interpreting multiple abdominal lesions as a coherent pattern while preserving an appropriate differential diagnosis. The combination of a right renal hilar mass, a separate lower-pole cortical lesion, a right adrenal mass, and a renal vein thrombus raises concern for multifocal malignant disease. Nevertheless, imaging similarity alone cannot establish that every lesion originates from the same primary tumor.

Clinical takeaway: In a patient with breast cancer, the distribution of lesions, their enhancement characteristics, diffusion behavior, vascular relationships, and the results of systemic staging should be evaluated together rather than in isolation.

2. Pathophysiology of Renal and Adrenal Metastases

2.1 Hematogenous dissemination

Breast cancer cells can spread through lymphatic channels and the bloodstream. Hematogenous dissemination involves invasion of vascular structures, survival in the circulation, arrest within distant microvasculature, extravasation, and subsequent growth within a new tissue microenvironment.

The kidneys receive substantial blood flow, providing an anatomical route through which circulating malignant cells may reach renal tissue. However, their rich vascular supply does not make renal metastasis a common presentation of breast cancer.

Metastatic deposits may develop within the renal parenchyma or, less commonly, involve the renal sinus or hilar region. Depending on their location and growth pattern, lesions can compress or displace vessels, distort the collecting system, or extend into adjacent structures.

Adrenal metastases arise through hematogenous dissemination and may remain asymptomatic. Their significance depends on the primary tumor, lesion characteristics, disease distribution, and whether adrenal function is affected.

2.2 Why multiple lesions matter

When the adrenal gland and kidney contain lesions with similar morphological and enhancement characteristics, metastatic disease becomes an important diagnostic consideration. Multiple lesions can suggest a common malignant process, particularly when the patient has a known primary cancer.

However, multiplicity is not pathognomonic. A primary renal malignancy can coexist with an unrelated adrenal adenoma, and separate primary tumors are also possible. The imaging interpretation must therefore distinguish a plausible unifying diagnosis from a histologically established diagnosis.

2.3 Renal hilar involvement and renal vein thrombosis

The renal hilum contains the renal artery, renal vein, lymphatic structures, and the renal pelvis. A mass in this region can displace or compress adjacent vessels and may be associated with vascular invasion or thrombosis.

Two principal forms of venous thrombus should be considered:

• Tumor thrombus: Intravascular extension of viable tumor tissue.

• Bland thrombus: Non-neoplastic clot associated with factors such as venous stasis, vascular injury, or cancer-associated hypercoagulability.

Mixed tumor and bland thrombi may coexist. Tumor thrombus may demonstrate internal enhancement and continuity with an adjacent tumor. Bland thrombus generally lacks convincing internal enhancement, although imaging findings must be interpreted in context.

The presence of a renal vein thrombus is clinically important, but it does not independently establish direct tumor invasion. Dedicated assessment of the renal vein and inferior vena cava may be required to define the extent of vascular involvement.

3. Epidemiology and Clinical Significance

Renal metastases are less common than primary renal malignancies in routine diagnostic practice. Breast cancer can metastasize to the kidney, but published evidence concerning this presentation includes relatively small series and case reports. Consequently, reliable population-level estimates specifically for breast cancer with simultaneous renal and adrenal metastases are limited.

Adrenal metastases are recognized in patients with several primary cancers, including breast and lung malignancies. Nevertheless, adrenal incidentalomas are also common, and many are benign.

The probability of metastatic disease depends on the clinical context. Important considerations include the original breast cancer stage, histological subtype, estrogen receptor (ER) and progesterone receptor (PR) status, HER2 status, previous treatment, interval since diagnosis, and the presence of metastases elsewhere.

The coexistence of renal and adrenal masses should prompt three practical questions:

1. Are the lesions metastases from the known breast primary?

2. Does the renal lesion represent a new primary malignancy, such as RCC?

3. Are malignant and benign lesions present simultaneously?

These distinctions influence whether tissue sampling is necessary, whether local intervention is appropriate, and which systemic treatment should be selected.

4. Clinical Presentation

4.1 Renal metastases

Renal metastases may be asymptomatic and detected during staging or surveillance imaging. When symptoms occur, they can include:

• Hematuria.

• Flank or abdominal pain.

• Nonspecific abdominal discomfort.

• Anemia.

• Changes in renal function.

These findings are not specific to metastases. RCC, urinary stones, infection, and other renal disorders can produce similar symptoms.

4.2 Adrenal metastases

Adrenal metastases are frequently asymptomatic. Unilateral adrenal involvement does not, by itself, establish adrenal insufficiency. However, extensive bilateral adrenal disease may warrant evaluation for impaired adrenal function when symptoms or laboratory abnormalities support that possibility.

Severe weakness, hypotension, unexplained electrolyte abnormalities, or other features suggestive of adrenal insufficiency require appropriate clinical assessment.

4.3 Clinical assessment in this case

The supplied case describes a woman in her 60s undergoing breast cancer staging MRI. The examination identifies multiple right-sided abdominal lesions and a small renal vein thrombus. The available case description does not establish the histopathological origin of every lesion or provide sufficient information to assign a definitive molecular subtype, final metastatic stage, or patient-specific prognosis.

These uncertainties should remain explicit until additional clinical, pathological, or follow-up evidence becomes available.

5. CT and MRI Imaging Features

5.1 Contrast-enhanced MRI

MRI provides excellent soft-tissue contrast and allows evaluation of lesion morphology, enhancement, diffusion characteristics, and relationships with surrounding structures.

In this case, the principal findings are:

• A lobulated right adrenal mass with heterogeneous enhancement.

• A large right renal hilar mass displacing adjacent vessels.

• A small separate posterior cortical mass in the right lower renal pole.

• A small thrombus within the right renal vein.

• Suspicious diffusion characteristics in the lesions.

• No suspicious hepatic metastasis identified in the described examination.

Heterogeneous enhancement may reflect variable vascularity, cellularity, necrosis, hemorrhage, or other internal tissue characteristics. It is a useful descriptive feature but cannot independently establish tumor origin.

Figure 1. Right Adrenal Mass on Axial Contrast-Enhanced MRI

Image interpretation: The axial contrast-enhanced MRI demonstrates a lobulated right adrenal mass with heterogeneous enhancement. The lesion is suspicious in the context of breast cancer staging, and adrenal metastasis should be considered alongside adenoma and other adrenal neoplasms.

Clinical significance: Dedicated adrenal characterization may include unenhanced CT attenuation, chemical-shift MRI, comparison with previous imaging, and additional assessment when indicated. Lesion morphology alone is insufficient to establish metastatic disease.

Figure 2. Right Renal Hilar Mass With Renal Vein Thrombus

Image interpretation: The axial contrast-enhanced MRI demonstrates a large right renal hilar mass displacing adjacent vessels. A small thrombus is present within the renal vein. The mass has heterogeneous enhancement similar to that described in the adrenal lesion.

Clinical significance: The relationship between the mass and renal vein requires careful evaluation. Internal thrombus enhancement, continuity with the adjacent mass, venous expansion, and possible extension into the inferior vena cava are relevant findings. The available image does not, by itself, prove that the thrombus contains tumor tissue.

Figure 3. Separate Posterior Cortical Mass in the Right Lower Renal Pole

Image interpretation: A small lesion is identified in the posterior cortex of the right lower renal pole, anatomically distinct from the larger hilar mass.

Clinical significance: The presence of a separate renal lesion raises the possibility of multifocal metastatic disease. However, multiple renal masses can also occur in other conditions. Each lesion should be evaluated for its enhancement pattern, anatomical origin, relationship to the collecting system, and interval change.

Figure 4. Diffusion-Weighted Imaging of the Renal and Adrenal Lesions

Image interpretation: The DWI image demonstrates high signal in a suspicious lesion, supporting the need to assess diffusion characteristics alongside conventional morphological sequences.

Clinical significance: High DWI signal may reflect restricted diffusion, but it may also result from T2 shine-through. DWI must therefore be interpreted with the corresponding ADC map. Diffusion restriction can occur in multiple malignant tumors and in selected benign or inflammatory lesions; it is not specific to breast cancer metastasis.

Figure 5. Apparent Diffusion Coefficient Map

Image interpretation: The ADC map provides complementary information for evaluating whether the DWI signal corresponds to true diffusion restriction. Reduced ADC signal in a corresponding lesion would support restricted water diffusion.

Clinical significance: No quantitative ADC measurement or validated lesion-specific threshold is provided in the case. Consequently, a numerical malignancy assessment cannot be made. ADC values should be interpreted with image quality, acquisition parameters, lesion morphology, enhancement, and the clinical context in mind.

Figure 6. Coronal Contrast-Enhanced MRI of the Right Renal and Adrenal Region

Image interpretation: The coronal MRI demonstrates the distribution of the right-sided lesions and their anatomical relationships. This plane complements axial imaging by clarifying the relative positions of the renal hilar and adrenal abnormalities.

Clinical significance: Multiplanar evaluation is important when assessing lesion origin, adjacent organ involvement, and the extent of suspected vascular invasion. Additional CT or MRI may be appropriate if the existing examination does not adequately define vascular anatomy.

6. Interpreting DWI and ADC Correctly

DWI measures signal changes related to the microscopic movement of water molecules. Highly cellular tumors may restrict water diffusion because their extracellular spaces are relatively limited. This can produce high signal on DWI and reduced signal on the ADC map.

The most important interpretive principle is that high DWI signal alone is not equivalent to confirmed restricted diffusion.

T2 shine-through occurs when a lesion with high T2 signal remains bright on DWI despite lacking a corresponding reduction in ADC. Reviewing both sequences helps distinguish this phenomenon from true diffusion restriction.

In the present case, the similarity of enhancement and diffusion characteristics across the renal and adrenal lesions supports considering a shared malignant process. Nevertheless, neither DWI nor ADC can determine whether a lesion originated in the breast, kidney, adrenal cortex, or another tissue.

Diffusion imaging should therefore complement, rather than replace, morphological imaging, clinical history, systemic staging, and histopathology when required.

7. Differential Diagnosis

7.1 Metastatic breast cancer

Metastatic breast cancer is an important consideration when renal and adrenal lesions develop in a patient with a known breast primary. Multiple lesions with similar imaging characteristics may support this interpretation, particularly when other findings indicate systemic disease.

However, a radiological suspicion of metastasis is not equivalent to pathological confirmation. The diagnostic conclusion should reflect the strength of the evidence and the clinical consequences of uncertainty.

7.2 Primary renal cell carcinoma

RCC is a major alternative diagnosis. Clear-cell RCC can demonstrate avid enhancement and may extend into the renal vein or inferior vena cava as tumor thrombus.

A dominant renal mass with venous involvement therefore requires careful evaluation for a primary renal malignancy. The presence of an adrenal lesion does not automatically establish metastatic breast cancer, because adrenal adenomas and unrelated neoplasms may coexist.

7.3 Adrenal adenoma

Adrenal adenomas are common benign lesions. A low attenuation value on unenhanced CT or signal loss on chemical-shift MRI can support the diagnosis of an adenoma containing intracellular lipid.

Lipid-poor adenomas can be more difficult to characterize. In patients with known malignancy, an indeterminate adrenal mass should be evaluated using the appropriate adrenal imaging pathway rather than classified solely by size or heterogeneous enhancement.

7.4 Adrenocortical carcinoma

Adrenocortical carcinoma is an uncommon but important malignant differential diagnosis. Large size, irregular morphology, necrosis, hemorrhage, local invasion, or hormone-related manifestations may raise suspicion.

Imaging findings can overlap with those of metastases. Endocrine assessment, multidisciplinary review, and appropriate pathological evaluation may be necessary.

7.5 Lymphoma and other metastatic tumors

Renal lymphoma can produce multiple lesions or infiltrative abnormalities and may be associated with lymphadenopathy. Other primary cancers, including lung and gastrointestinal malignancies and melanoma, can also metastasize to the kidney or adrenal glands.

The overall distribution of disease, lymph node findings, prior cancer history, and tissue characteristics should guide the differential diagnosis.

7.6 Bland renal vein thrombosis

A bland thrombus may develop in association with cancer-related hypercoagulability, venous stasis, or vascular injury. It should not be equated automatically with direct tumor invasion.

Contrast enhancement within the thrombus and continuity with a neighboring mass support tumor thrombus, whereas absent internal enhancement may favor bland thrombus. Neither interpretation should be made without considering the complete imaging and clinical picture.

8. Diagnostic Workup

A structured diagnostic approach can reduce uncertainty and help avoid inappropriate treatment.

Step 1: Review the clinical history. Establish the original breast cancer histology, stage, ER/PR status, HER2 status, prior treatment, and timing of the new lesions.

Step 2: Compare previous imaging. Determine whether the lesions are new, enlarging, stable, or previously characterized as benign. Growth patterns may be diagnostically informative.

Step 3: Characterize the renal lesions. Evaluate enhancement, margins, location, collecting-system relationships, multiplicity, and vascular involvement on appropriate CT or MRI sequences.

Step 4: Characterize the adrenal lesion. Review unenhanced CT attenuation, chemical-shift MRI, and other adrenal-specific imaging findings when appropriate. Endocrine testing should be guided by clinical and radiological indications.

Step 5: Define the extent of vascular involvement. Assess the renal vein, possible inferior vena cava extension, and any associated vascular complications. Distinguish suspected tumor thrombus from bland thrombus as far as imaging permits.

Step 6: Complete systemic staging when indicated. CT, MRI, or FDG PET/CT may be appropriate depending on the clinical scenario and the unresolved staging question. No single imaging strategy is necessary for every patient.

Step 7: Consider tissue sampling. Biopsy should be considered when imaging remains indeterminate, and the result is likely to change treatment. Before adrenal biopsy, pheochromocytoma must be appropriately excluded when relevant, and the potential risks and diagnostic limitations of the procedure should be reviewed.

When a new lesion could represent either a metastasis or a second primary cancer, histopathological confirmation may substantially alter management.

9. Treatment Strategies

Treatment should be individualized according to tumor biology, prior therapies, disease distribution, organ function, symptoms, and patient preferences. Renal or adrenal metastasis does not automatically require nephrectomy or adrenalectomy.

9.1 Systemic therapy

For confirmed metastatic breast cancer, systemic treatment is generally central to disease management. Treatment selection depends on the tumor's biological subtype and the patient's previous treatment history.

• Hormone receptor-positive, HER2-negative disease: Endocrine therapy combined with an appropriate targeted agent, such as a CDK4/6 inhibitor, is an important option in suitable patients.

• HER2-positive disease: HER2-directed therapy, often combined with other systemic agents, is selected according to treatment history and current recommendations.

• Triple-negative disease: Chemotherapy, immunotherapy in eligible patients, and biomarker-directed options may be considered according to the clinical setting.

• Biomarker-directed treatment: Additional testing, including germline or tumor molecular testing when indicated, may identify further treatment options.

Current guidelines should be consulted when choosing a regimen because treatment recommendations evolve as new evidence becomes available [1], [2].

9.2 Surgery and local treatment

Surgery is not automatically indicated for renal or adrenal metastases. In patients with disease involving multiple organs, systemic treatment may offer greater overall benefit than removing an individual lesion.

Local treatment may nevertheless be considered in selected circumstances, including symptomatic disease, a need for definitive tissue diagnosis, isolated or limited metastatic disease, or a specific local-control objective.

The potential benefits of surgery, ablation, or radiotherapy must be weighed against procedural morbidity, renal function, the extent of systemic disease, and alternative treatment options.

9.3 Management of renal vein thrombosis

The first step is to determine whether the thrombus is likely to be tumor thrombus, bland thrombus, or a combination.

Anticoagulation may be appropriate for bland thrombosis in selected patients, but the decision depends on thrombotic risk, bleeding risk, planned procedures, renal function, and the overall oncological context. Tumor thrombus requires management directed at the underlying malignancy and the extent of vascular involvement; anticoagulation is not automatically indicated solely because tumor thrombus is present.

Urology, medical oncology, radiology, and other relevant specialists should review the findings when vascular invasion or thromboembolic complications may affect treatment.

10. Prognosis and Follow-Up

The prognosis of metastatic breast cancer varies considerably. Renal or adrenal involvement alone cannot establish an individual patient's expected survival.

Important prognostic factors include:

• ER/PR and HER2 status and other relevant tumor biomarkers.

• The number and distribution of metastatic sites.

• Overall tumor burden and the presence of visceral involvement.

• Response to systemic therapy.

• Performance status and comorbidities.

• Renal function and the extent of vascular involvement.

• The availability and effectiveness of subsequent treatment options.

The absence of a suspicious hepatic lesion in this case is one component of the imaging assessment, but it does not exclude metastases elsewhere or independently establish a favorable prognosis.

Follow-up imaging should use reproducible techniques and measurements whenever possible. Changes in lesion size, enhancement, new metastatic sites, vascular involvement, and treatment-related complications should be assessed alongside clinical findings and laboratory results.

The timing and modality of follow-up should be individualized according to treatment, disease behavior, symptoms, and the specific clinical question.

11. Practical Radiology Checklist

When evaluating renal and adrenal masses in a patient with breast cancer, radiologists should systematically address the following:

1. Anatomical origin: Is the lesion adrenal, cortical, hilar, or retroperitoneal?

2. Morphology: Are the margins smooth or irregular? Is there necrosis or hemorrhage?

3. Enhancement: Is enhancement homogeneous or heterogeneous, and how does it compare across lesions?

4. Diffusion: Does high DWI signal correspond to reduced ADC?

5. Vascular involvement: Is the renal vein displaced, compressed, invaded, or thrombosed?

6. Thrombus characterization: Is there internal enhancement or continuity with the adjacent mass?

7. Multifocality: Are lesions present in more than one renal location or organ?

8. Systemic distribution: Are other metastatic sites present?

9. Interval change: How do the lesions compare with prior imaging?

10. Management implications: Would additional imaging or tissue sampling change the treatment plan?

A useful radiology report should communicate not only what is visible but also the degree of diagnostic confidence, the important alternatives, and any additional evaluation required for treatment planning.

12. Three Case-Based Questions

Question 1: Multiple Renal and Adrenal Masses

A woman in her 60s with breast cancer undergoes staging MRI. A lobulated right adrenal mass, a large right renal hilar mass, and a separate small right lower-pole cortical lesion demonstrate heterogeneous enhancement and suspicious diffusion characteristics. Which interpretation is most appropriate?

A. All lesions are benign adenomas.
B. Restricted diffusion establishes lymphoma.
C. Metastatic disease is an important consideration, but primary renal or adrenal tumors must also be evaluated.
D. The absence of a suspicious liver lesion excludes distant metastases.
E. Multiple renal lesions definitively establish RCC.

Correct answer: C.

Explanation: Multiple lesions with similar imaging characteristics may reflect a common metastatic process in a patient with known breast cancer. However, imaging similarity and diffusion restriction are not specific enough to establish histological origin. RCC, adrenal neoplasms, lymphoma, and coexisting benign lesions remain relevant alternatives.

Question 2: Renal Vein Thrombus

A patient with breast cancer has a right renal hilar mass and a renal vein thrombus on contrast-enhanced MRI. Which imaging feature most strongly supports tumor thrombus rather than bland thrombus?

A. The patient's age.
B. Internal thrombus enhancement and continuity with the adjacent tumor.
C. High DWI signal alone.
D. The absence of hepatic metastases.
E. The presence of any malignancy in the patient's history.

Correct answer: B.

Explanation: Internal enhancement and continuity with an adjacent tumor support intravascular tumor extension. Bland thrombus generally lacks convincing internal enhancement. Nevertheless, imaging findings must be interpreted together with vascular anatomy, clinical risk factors, and the possibility of mixed thrombus.

Question 3: DWI and ADC Interpretation

A renal lesion demonstrates high signal on DWI. Which approach is most appropriate for determining whether this represents true restricted diffusion?

A. Diagnose malignancy based on DWI alone.
B. Review the ADC map and correlate the findings with morphological imaging and clinical history.
C. Ignore the ADC map.
D. Diagnose metastatic breast cancer whenever diffusion restriction is present.
E. Disregard contrast-enhanced imaging.

Correct answer: B.

Explanation: High DWI signal can result from true diffusion restriction or T2 shine-through. Corresponding ADC findings help distinguish these possibilities. Even confirmed restricted diffusion does not establish malignancy or identify the primary tumor; the complete imaging pattern and clinical context remain essential.

13. Conclusion

Breast cancer with suspected renal and adrenal metastases is a diagnostically challenging presentation that requires integrated interpretation of clinical history, anatomical distribution, contrast enhancement, diffusion imaging, and vascular findings.

In this case, the right adrenal mass, right renal hilar mass, separate lower-pole renal lesion, and renal vein thrombus collectively raise concern for metastatic disease. However, the distinction between metastases and primary renal or adrenal neoplasms remains important, and the thrombus cannot be classified definitively as tumor thrombus from its presence alone.

The most effective approach combines systematic CT and MRI assessment, appropriate systemic staging, selective tissue confirmation, and multidisciplinary treatment planning. The goal is not simply to identify an abnormal mass, but to establish a sufficiently reliable diagnosis to guide the safest and most appropriate management strategy.

References

[1] D. Trapani et al., “Updated treatment recommendations for systemic treatment: from the ESMO Metastatic Breast Cancer Living Guideline,” Annals of Oncology, vol. 36, no. 11, pp. 1414–1418, 2025, doi: 10.1016/j.annonc.2025.07.017.

[2] S. Al Sukhun et al., “Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource-Stratified Guideline,” JCO Global Oncology, vol. 10, art. no. e2300285, 2024, doi: 10.1200/GO.23.00285.

[3] D. Lother et al., “Imaging in metastatic breast cancer, CT, PET/CT, MRI, WB-DWI, CCA: review and new perspectives,” Cancer Imaging, vol. 23, art. no. 53, 2023, doi: 10.1186/s40644-023-00557-8.

[4] B. Gilbert, L. Z. Cordova, and A. Eaton, “Metastatic breast cancer masquerading as a renal malignancy: A literature review and case report,” Urology Case Reports, vol. 24, art. no. 100859, 2019, doi: 10.1016/j.eucr.2019.100859.

[5] M. McDonald et al., “ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer,” Journal of the American College of Radiology, vol. 21, no. 6S, pp. S168–S202, 2024, doi: 10.1016/j.jacr.2024.02.021.

[6] Expert Panel on Breast Imaging et al., “ACR Appropriateness Criteria® Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women,” Journal of the American College of Radiology, vol. 16, no. 11S, pp. S428–S439, 2019, doi: 10.1016/j.jacr.2019.05.024.

[7] M. Iima, M. Kataoka, M. Honda, and D. Le Bihan, “Diffusion-Weighted MRI for the Assessment of Molecular Prognostic Biomarkers in Breast Cancer,” Korean Journal of Radiology, vol. 25, no. 7, pp. 623–633, 2024, doi: 10.3348/kjr.2023.1188.

[8] S. C. Partridge et al., “Diffusion-weighted breast MRI: Clinical applications and emerging techniques,” Journal of Magnetic Resonance Imaging, vol. 45, no. 2, pp. 337–355, 2017, doi: 10.1002/jmri.25479.

[9] “Update on CT and MRI of Adrenal Nodules,” American Journal of Roentgenology, doi: 10.2214/AJR.16.17758.

[10] “Infiltrative Renal Malignancies: Imaging Features, Prognostic Implications, and Mimics,” RadioGraphics, doi: 10.1148/rg.2021200123.

[11] “Adrenal Lesions: A Review of Imaging,” Diagnostics, vol. 12, no. 9, art. no. 2171, 2022, doi: 10.3390/diagnostics12092171.

Medical Disclaimer

This article is intended for medical education and professional discussion. It does not replace individualized clinical assessment, formal radiological reporting, histopathological diagnosis, or multidisciplinary treatment planning.