Background: Ductal disease is a significant, frequently missed & poorly understood problem in breast imaging that causes delays in diagnosis and patient management. The most common reported symptom among ductal lesions is pathological nipple discharge.

Objective: The study aimed to find out the accuracy of MRI in the evaluation of Indeterminate intra ductal breast lesions (BIRADS 3, 4 and 5) using pathological examination as the golden standard.
Subjects and methods: Thirty female patients were subjected to this prospective cross-sectional study; they were referred to the radio diagnosis department from the surgery department in our hospital. All patients have a full clinical examination, ultrasound evaluation, pre and post-contrast dynamic MRI, and pathological evaluation.
Results: There was a remarkable variation (p < 0.05) between benign and malignant lesions regarding size, margin, and shape. There was a highly significant variation (p < 0.001) between malignant and benign lesions regarding MRI features of intra-ductal lesions (pattern of enhancement, dynamically enhanced curve, Diffusion weighted imaging (DWI), and MRI criteria). Concerning the validity of MRI in the diagnosis of the malignant intraductal lesion, where, sensitivity was 100%, specificity (89.5%), positive predictive value (84.6%), negative predictive value (100%), and accuracy (93.33%).
Conclusion: The present findings revealed that dynamic contrast enhanced MRI (DCE-MRI) and DWI-MRI have a significant accuracy in predicting the upgrade risk of US indeterminate intra ductal breast lesions, and it can decrease overtreatment and misdiagnosis.