Interactive Transcript
0:01
So our next group of cases was characterized as BI-RADS 5.
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We'll go through these one by one.
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So our first case is a 50 year old woman with an outside mammogram and ultrasound
0:14
showing a suspicious mass in the left breast.
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And this had not yet been biopsied,
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so we didn't have biopsy proof of what this was.
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An MRI was requested for further evaluation.
0:29
I think there was some delay getting the biopsy done.
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So in the meantime, they did an MRI.
0:34
So here's her MRI, and we'll start with the MIP.
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And the MIP image shows moderate background enhancement,
0:44
which is really characterized by scattered foci of enhancement.
0:48
These sort of similar appearing foci bilaterally.
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And then there's an enhancing mass here
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in the left posterior breast, kind of suspicious looking.
1:00
So we will go and take a look at some of these other sequences.
1:05
So I'm just going to pull in our usual
1:07
friends, the T1-weighted non-fat saturated sequence and the first post contrast subs,
1:15
and just take a look at this.
1:18
So if we start from the top, we can see that there's a very large lymph
1:24
node in the left axilla, which is abnormal.
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And then as we scroll down, we get into this mass,
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that's homogeneously enhancing, irregular, and that is suspicious.
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So that will need a biopsy.
1:45
This patient had had previous surgery on the right side.
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So you can see that over here, sort of distortion,
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but without enhancement.
1:58
Just going down through her breast tissue.
2:01
So there are some other areas of enhancement.
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There's sort of an elongated oval mass here and there's some linear non mass
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enhancement here on the left side, really quite discreet from the rest
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of the tissue.
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And then back into that mass again.
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Everything else looks like foci.
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So, I think the first step
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is going to be to recommend a second look ultrasound and biopsy of the abnormal
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looking lymph node and the mass in the left upper outer posterior breast.
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And then furthermore, one could consider
3:03
biopsy of this linear non mass, which is quite a distance away,
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and then consider evaluation of this oval mass in the right breast.
3:15
And if I remember correctly, the oval mass was stable mammographically
3:21
for several years, but this hadn't been seen before.
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So the linear non mass was biopsied using MRI guidance and that was benign.
3:31
So the patient was able to have treatment
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for this area, which was a cancer, diagnosed by ultrasound-guided biopsy.
3:40
And the lymph node did demonstrate metastatic disease.
3:46
And our other sequences basically show similar findings.
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These are our source images.
3:56
Sometimes the additional imaging gives you a little bit more information.
4:00
And the second and third post contrast series, we're usually, you know,
4:06
using them for sort of confirmation and for kinetic information.
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But our best source of information is
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usually going to be this first post contrast sequence and in comparison
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to the precontrast, which essentially gives you the subtraction images.
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Okay.
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And that's pre and post contrast imaging of that mass.
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