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So, this is a woman in her early 70s who

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had heterogeneously dense breasts, almost

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extremely dense breasts, if you look at the

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very dense anterior areas, that opted for

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supplemental screening with abbreviated MR.

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And the way we do this is, of course, there's a

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scout, which you can see in the upper left here.

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And then we do a T2 study here, and we're looking

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here for obviously any fluid

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collections, anything like that.

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And it's important when we

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are characterizing lesions.

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And then we have our pre-contrast study here,

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and you can see how dense her breasts are.

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And you don't see any obvious

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abnormality here, but we then inject

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contrast and initially we waited about

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30 seconds, but we're finding some women

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with poor cardiac output weren't getting

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good background parenchymal enhancement.

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So, we now draw an ROI on the aorta to

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make sure that there is actually cardiac

0:58

output before we do the post contrast.

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So, this is her non-sub post-contrast image, and

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I think you can see over here on the right side

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an enhancing lesion that actually looks a little

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bit irregular bordering her glandular tissue.

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And so, if I show you where that

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is, you can see it's not too bright.

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It's,

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you know, avidly enhancing.

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And if I show you my subtraction image, which

1:26

I'm going to drag, well, this is her MIP as well.

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And you can see the lesion.

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One thing I should mention is I

1:31

think it's a good thing to do.

1:33

Uh, look at the MIP kind of first

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to get an overall of her breasts and

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everything in the symmetry, et cetera.

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And you can obviously see this

1:39

standing out as a dominant lesion.

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So now let's look at the subtraction image.

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Again, here and there's the lesion standing out.

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No other lesions, no adenopathy,

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nothing in the other breast.

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And so, that's a suspicious lesion, obviously.

1:56

So now you might say, well,

1:58

what's her mammogram look like?

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So, let's take a look at that.

2:03

So here you can see her mammogram and you'd

2:05

expect this to be out in the lateral right breast.

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This is her synthetic image.

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Let's see what it looks like on her Tomo.

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So here's her Tomo and I'm scrolling through this.

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And the question is, in retrospect,

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is there anything maybe that's

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distorting or a mass that can be seen?

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And I don't know, you know, there's a little

2:26

area of density and you can begin to imagine.

2:29

Maybe there's something there,

2:30

but I don't think it's really.

2:32

You know, very evident.

2:33

This is her MLO

2:34

synthetic view.

2:34

And again, there's nothing that really stands out.

2:38

I'm going to pull up her Tomo of the right

2:42

breast here, enlarge it a little bit.

2:44

Let's see if we can see anything.

2:46

We're going over in the lateral breast.

2:48

Is there anything that 1 can correlate?

2:50

So, no, yeah, that makes you feel pretty

2:53

good, but doesn't answer the question.

2:56

So, the next step for her would really be a

2:59

targeted ultrasound because it is a little mass.

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And certainly, if it can be seen on

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ultrasound, it's an easier biopsy for her.

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I think it's an easier biopsy for me as well.

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And that's what we generally do.

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It also takes less time on the

3:13

very expensive magnet, etc.

3:15

So, let me show you the ultrasound study.

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So here's targeted scanning of her right breast.

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What you see is really what correlates

3:24

with the MR finding a small mass.

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It looks a little bit taller than wide in the

3:28

right location, 10 o'clock in the right breast.

3:30

And so this was indeed biopsied

3:32

under ultrasound-guided core biopsy.

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And this is actually a small

3:36

invasive lobular carcinoma.

3:38

I would have thought it was ductal, but it's not.

3:39

Anyway, an invasive lobular carcinoma,

3:42

she went on to have a very limited

3:43

lumpectomy and a sentinel node dissection.

3:46

And of course, with a small lesion, unlikely to

3:48

have any positive nodes, no positive nodes at all.

3:51

So, early detection of an

3:52

invasive lobular carcinoma.