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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 2 min.
2 topics, 5 min.
5 topics, 33 min.
3 topics, 14 min.
8 topics, 28 min.
4 topics, 20 min.
4 topics, 25 min.
22 topics, 1 hr. 17 min.
BI-RADS Assessment Categories – Overview
11 m.BI-RADS 1
5 m.BI-RADS 2 – Left Lumpectomy
4 m.BI-RADS 2 – Right Lumpectomy, Right Non-Enhancing Mass
2 m.BI-RADS 2 – Left Post Excisional Biopsy Change
3 m.BI-RADS 2 – Marked BPE, Stable
3 m.BI-RADS 2 – Bilateral Stable Findings
4 m.New focus of enhancement on a high risk patient (BI-RADS 4)
3 m.BI-RADS 3 – Changing Pattern of Background
2 m.BI-RADS 4 – Linear NME, Left Breast
4 m.BI-RADS 4 – Right Extensive DCIS, Left Dominant Focus
4 m.BI-RADS 4 – New Diagnosis Left Cancer, Focal NME left
3 m.BI-RADS 4 – New Diagnosis Right Breast Cancer, Nodes on Right
5 m.BI-RADS 4 – Left Axillary Node Metastasis, Evaluate for Breast Cancer
3 m.BI-RADS 5 – Suspicious Mass in Left Breast, Not Biopsied Yet
5 m.BI-RADS 5 – Left Breast Cancer, MRI Shows Right Cancer
5 m.BI-RADS 5 – New Diagnosis Right Cancer, Suspicious Masses in Right Breast
3 m.BI-RADS 5 – Right Inflammatory Cancer, Bilateral Nodes
4 m.BI-RADS 6 – Right Breast Cancer, No Other Findings
3 m.BI-RADS 6 – Left Breast Cancer, No Other Findings
2 m.BI-RADS 6 – Left Breast Cancer, Index Mass
4 m.BI-RADS 6 – Pre and Post Neoadjuvant Chemotherapy (NAC) for Left Breast Cancer
5 m.0:01
Our next group is BI-RADS 3 cases.
0:05
And our first case is a 60-year-old
0:07
woman seen for high-risk screening.
0:10
She has a history of right breast
0:12
cancer 10 years ago, and a strong
0:14
family history of breast cancer.
0:17
And this is her MRI exam.
0:20
You can see that she has some background
0:22
enhancements, some blood vessels,
0:25
and there's a little bright focus of
0:27
enhancement here in the left breast.
0:31
So we're going to go back and
0:34
investigate a little bit more.
0:36
So here's a T1 non-FATSAT
0:39
and our subtracted images.
0:44
So we can see that she has
0:49
some areas; she looks kind of heterogeneous,
0:51
and others, she looks sort of scattered
0:53
fibroglandular, so probably heterogeneous tissue.
0:59
21 00:01:00,285 --> 00:01:02,285 We can see on her T1 that
1:02
she has had a lumpectomy.
1:05
You can see scarring here in the right
1:09
upper breast, with multiple surgical
1:12
clips, with a susceptibility artifact.
1:18
So that right side has had surgery.
1:22
On the left side, the only thing
1:24
that we're seeing is this focus.
1:26
Well, she does have some other foci,
1:29
but this one really stands out as being unique.
1:34
She does have some scattered findings,
1:35
but that one is really standing out.
1:38
Okay.
1:39
So then we would look at prior images
1:43
because we'd want to know whether
1:45
that was new or old and we're just
1:49
going through other series as well.
1:52
This is T1
1:57
with fat saturation before and after
1:59
contrast, and we find that we can see
2:03
that little focus lighting up there.
2:06
And when we went to the prior
2:08
images, that was not present.
2:10
And in this case, we did a biopsy,
2:12
which was benign, but if this were the
2:16
patient's baseline exam, you know, one
2:20
could imagine that this unique focus could
2:23
be followed as a six-month follow-up.
2:27
And even if it were T2 hypointense.
2:31
So I think that the message here is that it
2:35
kind of depends on the setting, you know,
2:37
in this case we had a patient who had had
2:39
multiple prior exams and this was a
2:42
new finding, and therefore warranted biopsy.
2:47
If this were a baseline exam
2:49
for baseline high-risk screening exam.
2:52
This is something that we would
2:53
probably follow over time.
Interactive Transcript
0:01
Our next group is BI-RADS 3 cases.
0:05
And our first case is a 60-year-old
0:07
woman seen for high-risk screening.
0:10
She has a history of right breast
0:12
cancer 10 years ago, and a strong
0:14
family history of breast cancer.
0:17
And this is her MRI exam.
0:20
You can see that she has some background
0:22
enhancements, some blood vessels,
0:25
and there's a little bright focus of
0:27
enhancement here in the left breast.
0:31
So we're going to go back and
0:34
investigate a little bit more.
0:36
So here's a T1 non-FATSAT
0:39
and our subtracted images.
0:44
So we can see that she has
0:49
some areas; she looks kind of heterogeneous,
0:51
and others, she looks sort of scattered
0:53
fibroglandular, so probably heterogeneous tissue.
0:59
21 00:01:00,285 --> 00:01:02,285 We can see on her T1 that
1:02
she has had a lumpectomy.
1:05
You can see scarring here in the right
1:09
upper breast, with multiple surgical
1:12
clips, with a susceptibility artifact.
1:18
So that right side has had surgery.
1:22
On the left side, the only thing
1:24
that we're seeing is this focus.
1:26
Well, she does have some other foci,
1:29
but this one really stands out as being unique.
1:34
She does have some scattered findings,
1:35
but that one is really standing out.
1:38
Okay.
1:39
So then we would look at prior images
1:43
because we'd want to know whether
1:45
that was new or old and we're just
1:49
going through other series as well.
1:52
This is T1
1:57
with fat saturation before and after
1:59
contrast, and we find that we can see
2:03
that little focus lighting up there.
2:06
And when we went to the prior
2:08
images, that was not present.
2:10
And in this case, we did a biopsy,
2:12
which was benign, but if this were the
2:16
patient's baseline exam, you know, one
2:20
could imagine that this unique focus could
2:23
be followed as a six-month follow-up.
2:27
And even if it were T2 hypointense.
2:31
So I think that the message here is that it
2:35
kind of depends on the setting, you know,
2:37
in this case we had a patient who had had
2:39
multiple prior exams and this was a
2:42
new finding, and therefore warranted biopsy.
2:47
If this were a baseline exam
2:49
for baseline high-risk screening exam.
2:52
This is something that we would
2:53
probably follow over time.
Report
Description
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Neoplastic
MRI
Breast
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