Interactive Transcript
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Now we have a comparison case for this,
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and then we'll talk a little bit more about these things.
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And that is this case here.
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I also have a mammogram to show you on this.
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This is case number four.
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This is a 54-year-old who presented
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with right breast pain and swelling.
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I'll just give you a moment looking at that.
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And then we're going to go over to the MRI.
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What I'm showing you on the left-hand image here,
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let's brighten up a little bit for you,
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is the subtraction gadolinium-enhanced...
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I'm sorry,
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on the right-hand image is a T2, left-hand image is a T2.
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Got myself confused here.
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This is T2 here.
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And on the right-hand side is the subtraction after gadolinium.
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So I'm going to scan
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through those a little bit.
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Coming up.
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And then we're up in the right axilla now.
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And I'm also going to show you the CAD MIP,
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Let's make sure it's got the same orientation.
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So, this is the right breast, the symptomatic breast on this side.
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Can we have the poll go up, please?
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Let's see the results of that.
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Okay, nice.
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So most people got this inflammatory breast cancer.
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So let's look at the similarities
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and the differences between this study and the prior study.
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On the mammogram,
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apart from it being the opposite breast, the changes are very similar.
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We have diffuse skin thickening.
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We've got enlargement.
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We've got increased diffuse density and we've got coarsening of the trabeculae.
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The differences really come on the MRI.
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Now, on the T2 images, there is still a high T2 signal throughout
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that right breast, similar to we saw in the last patient.
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Again, we can see the skin thickening, although it's much more unilateral this time.
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And we can see high T2 signal within the skin.
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The difference is really
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in the enhancement pattern, I'll get rid of this MIP,
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and we'll go back and look at that subtraction.
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Just flip it a little bit there.
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Give it a little bit...
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A little windowing to help here.
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And what we're seeing on this is
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A. This patient has a lot of enhancement within
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the breast parenchyma itself, multiple speculated masses.
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And we have enhancement of the trabeculae.
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So what we're seeing down here are the trabeculae themselves,
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which were thickened on the patient's mammogram are enhancing.
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And then is skin enhancement.
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And that is really important for making
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the diagnosis of inflammatory breast cancer.
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When we go further up the breast,
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all the way,
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we can see she has some small lymph nodes up in this
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left axilla, but really nothing sort of very prominent.
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Certainly not anything that you
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would expect to give lymphedema, which was one of the other choices.
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So there is a significant differential
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for patients who have diffuse swelling of a breast and thickening
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of the trabeculae on the mammograms.
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Similar to those two mammograms.
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Inflammatory breast cancer is always the one that we are concerned about,
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and that's the one that we need to make sure that we're not going to miss.
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For inflammatory breast cancer,
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you're going to see multiple areas of enhancement within the breast
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with enhancing trabeculae, diffuse skin thickening, with enhancement to the skin.
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We can't make the diagnosis
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of inflammatory breast cancer from an MRI, but we can certainly suggest it.
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And if they haven't already,
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we would recommend they do a skin biopsy to make that diagnosis.
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With lymphedema and cardiac failure, you're going to see, again, high T2 signal,
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again, skin thickening, but you should not see enhancement of the trabeculae.
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You should not see enhancement of the skin.
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With patients who have diffuse mastitis, it gets a little bit more tricky.
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Nobody should really be imaging patients
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who have acute mastitis by MRI because you're likely to get yourself into a lot
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of trouble, because it's going to have a lot of features which are very similar.
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It does not usually have this degree of intense wash-out.
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It's not usually this diffused,
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it tends to be more local, but you will have some skin enhancement.
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Not as much skin enhancement as you do here.
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You'll certainly have skin edema.
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But most of the enhancement tends to be
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within the breast parenchyma rather than the skin.
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