Interactive Transcript
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So our next topic is enhancing MRI findings.
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These are the things that we look at on MRI that
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enhance with contrast and how we describe them.
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So the three major areas are a focus,
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a mass, or non-mass enhancement.
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And then, of course, lymph nodes.
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We're always looking at lymph nodes
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in the breast, in the axilla, and
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in the internal mammary space.
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Focus is an enhancing dot less
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than five millimeters in size.
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The shape and margin cannot be seen clearly.
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It's not clearly space-occupying, and
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it can't be further characterized.
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It also should be unique compared to background
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parenchymal enhancement, and typically scattered
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foci of enhancement represent background.
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This is an example of a focus indicated by the
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yellow arrow, so just this little dot here.
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The other dots in the image are actually
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parts of blood vessels, so as you scroll
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through you can see the difference.
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This is another focus, a little bit larger.
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And you can see that this is really
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unique compared to the background.
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There's nothing else that looks like that.
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So benign features would include
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foci that are not unique.
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So background parenchymal enhancement foci.
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Ones that are high signal on bright fluid
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imaging, which is, you know, T2 or STR.
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Fatty hilum, which would indicate
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a possible small lymph node.
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persistent kinetics, and stable
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or seen on a baseline study.
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Suspicious features would be those that
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are unique from the background, not
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bright on T2-weighted imaging, no fatty
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hilum, washout kinetics, and increased
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or new compared to the prior study.
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And this algorithm is from a training
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session for an abbreviated MRI study
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that was done by Chris Comstock and
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Christiana Kuhl and a group of researchers.
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These algorithms that I'm going to show
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apply to an approach to interpretation
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of a baseline abbreviated MRI, and we've
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kind of extrapolated them a little bit
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to use them for a full protocol MRI
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as well, but just keep that in mind.
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So for a unique three to five
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millimeter focus on the baseline exam,
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if it's just an inflammatory cyst,
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we're going to consider that benign.
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If the focus has circumscribed
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margins and is high T2 signal, we're
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going to consider that one benign.
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If it doesn't have high T2 signal,
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then we have to look at, you know,
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does it have rim enhancement or not?
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If it does, we'll biopsy it.
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If it doesn't, we're going
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to follow it in six months.
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And then, of course, if a focus has irregular
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shape or margins, we should biopsy it.
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