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Alright, so what we've got here is...

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I'm going to show you, first of all, her...

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I'm going to show you this lady's mammogram.

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So kind of a spectacular mammogram. Didn't really need the...

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We didn't do the MRI to assess for rupture, but she's a 68-year-old who is now

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26 years status post bilateral breast implants,

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who is complaining of considerable deformity in her breast.

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And they were concerned that they could not assess her for malignancy on the basis

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of this sort of really challenging mammogram here.

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So she was preferred instead for an MRI.

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So let's see if we can call those ones up here.

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All right, what we're going to look at here is...

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we're going to have her gadolinium-enhanced study on the left when

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it's booted up and the subtraction on the right.

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Now, these all beautifully ready to go as of 3:45.

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All right, so let's look at this.

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So this is a silicon dark sequence

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and this is

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no gadolinium on this...

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This image here is no gad, silicon dark.

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I'm going to link it with the gadolinium-enhanced image, which is on the right.

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And then, I'm going to show you the non-fat sated pre gadolinium.

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Take a look at that for one moment.

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I'm just going to bring up the...

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non-fat sat.

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Give it a moment to load.

2:21

Right.

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So, the image on the left is not fat suppressed.

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The image on the right is fat suppressed.

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So can you put that poll up, please?

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While you're answering that, I'm just going to load the next case

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in case. We'll check they haven't disappeared on me.

2:37

Good.

2:38

We've got intra and extracapsular rupture, which most of you are going for.

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So this clearly, in this patient, I mean, you can tell from the mammogram,

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to be honest, has silicon outside of their capsule.

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So we've got dark silicon, we have dark silicon here,

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but we've also got dark skille...

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silicon within the breast parenchyma.

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Now, there is a little bit of enhancement.

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You can just see around some of these chunks of silicon.

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They will often have a little bit of an inflammatory.

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You can see a little

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bit of enhancement all the way around these great globs of silicon.

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It will invoke an inflammatory response.

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You see it again here in the right breast.

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One of the big differentials for

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sort of something funky like this is going to be fat necrosis.

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But for fat necrosis in these enhancing centrally within

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the areas of enhancement, we should be seeing

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high signal on the non-fat enhanced where we're seeing low signals.

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So this is not fat within them, this is silicon.

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So MRI is a good means of screening patients of breast cancer who have

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extensive intra and extracapsular silicon, such as this patient here.

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But it's...

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you will see, as I said, some kind of rim enhancement around the silicon.

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You're going to have to look clearly each area of enhancement to say, you know,

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is there a global silicon within it or is it a mass by itself?

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It's also quite a good way of looking

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at patients who have had free silicon injections into their breasts,

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such as done in some countries, which are completely hopeless to look at by...

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mammographically.

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Really, in those patients, you have to look upon their first study as

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being the baseline study of which,

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after which you're going to have

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a comparative one, because even the baseline study is usually so abnormal.