0:01

This is a high risk screening MRI. And again, this is the,

0:04

I like to kind of start by looking at the myth image to see if

0:06

anything stands out. And right away on this myth image,

0:10

we see this focus in the outer right breast. It sort of stands out.

0:15

It's a little bit brighter than her other kind of scattered

0:18

foci around the breast. She does have other enhancing foci throughout both

0:23

breasts, but this one looks a little bit bigger and a little bit

0:25

brighter, which stands out to us. Then we can look at the

0:30

post contrast and find that focus. And here it is in the lower

0:42

outer right breast, anterior depth. It's a dominant focus.

0:51

The next thing we want to do is similar to our last cases.

0:54

We want to see if there is a T2 correlate. And in this

0:58

case, there was not. So here we are sort of matched up on

1:03

the slices and we're not seeing anything that's T2 right at that site.

1:09

This is another finding that is appropriate for BI RADS 3 is a

1:14

dominant or a unique enhancing focus, which does not have a T2 correlate.

1:22

This actually, our institution was biopsied and was benign.

1:29

We don't have the kinetics on this case, but if there's mixed feelings on

1:33

whether the kinetics are actually helpful for enhancing foci because they're

1:37

so small, but as is would be expected, if we're seeing persistent kinetics,

1:43

that would be a reassuring sign. And if we saw washout kinetics, that

1:49

would be more suspicious. And I think with this, if there was

1:54

suspicious kinetics, I would have a low threshold to do an MRI biopsy

1:58

instead of following. But like I mentioned before, this is kind of an

2:03

evolving topic and the recommendation to follow an enhancing focus without

2:10

a T2 correlate is really based on expert opinion.

2:14

The studies have been sort of back and forth on

2:17

whether there is truly a less than 2% chance of malignancy, but it's

2:22

clear that there's at least a very low chance of malignancy for this

2:25

finding. And a six month follow up is a reasonable recommendation.