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Enhancing MRI Findings

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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.

Report

Description

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Tags

Women's Health

MRI

Breast

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