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Hello, everybody.

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I'm just going to put my video on just very briefly, so you actually have a face

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to put with the sort of mystery voice, and then I'm going to take it off.

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I am talking to you today from an extremely snowy New Hampshire.

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And for those of you who live in climates that are little warmer than this,

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this is what my deck looks like right now.

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There was no snow on the deck whatsoever yesterday, and now I have over two foot.

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And this was the car park when I came

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to get my car out to come home this afternoon.

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So kind of fun and games here.

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So what I'm going to be talking about today is, I'm going to be

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talking about breast MRI cases, but in particular, I've put cases together

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that have features that are similar and may be mistaken for each other.

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And we're going to go through sort of some of the differences, differentiating them.

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So what I'm showing you here is the axial

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and the sagittal of a patient who is a 54-year-old high risk screener.

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And what I want you to focus on is this left breast.

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The left hand image is the subtraction

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gadolinium-enhanced one, and the right hand image is the delayed sagittal.

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So, let's go through this one first of all.

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Going to do this slowly so you don't whiz past it.

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And I want you to look at this

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abnormality in the left retroareolar area.

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And particularly, I want you looking at

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the differences between this on the left and this on the right.

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And then, I'm just going to go across and show you the sagittal.

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This is the right sagittal nipple area.

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Let me just move that out of the way.

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And this is the left sagittal nipple area.

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After the examination, she was called back and we took her to ultrasound.

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And I'm going to show you an image of her left retroareolar ultrasound.

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And can you put the first question up, please?

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I'll go back to the MRI.

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Don't know if it shows the result of that.

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All right.

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Well, we got quite a spread

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considering the number of people we've got on board here.

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So we've got a bit of everything.

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So, this is a normal variant. This is a left inverted nipple.

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What you might be a little confused by is if you're looking at...

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Sorry, I can't get this to zoom up.

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Nope, it doesn't want to today.

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If you remember, in breast MRI,

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we put little positive contrast markers on the nipple.

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You can see the marker here on the outside of the normal right nipple,

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and the marker here on the outside of the inverted left nipple.

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And because there is normal nipple

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enhancement in women, if their nipples are inverted, then that enhancement

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appears it's subareolar, if you're not looking at it closely.

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And we took her to ultrasound,

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we could see the nipple was clearly inverted.

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Now, I can confess to you that I have once done an MRI-guided biopsy of a patient

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who was put on for biopsy by one of my colleagues, not myself.

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And I wasn't smart enough to go

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in and look at the woman's breast before she was put in the magnet,

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and we, you know,

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and then I couldn't see anything much,

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and we did the biopsy, and I have biopsied an inverted nipple.

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It came back as normal nipple, and that nipple was no more.

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On the plus side, she's never seen it, so, and she never was going to.