Interactive Transcript
0:01
So, uh, I want to show you a case of
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this protocol, and it's actually the
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same patient that we just looked at, but
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we'll be, um, scrolling through, uh, the
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images, and, uh, this is a 43-year-old
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woman who was seen for high-risk screening.
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So, this is a case just to show
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you what our protocol looks like.
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This first view is the three-plane localizer.
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So, here's our coronal
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sequence, and then sagittal
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through each breast, and then axial
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coronal again.
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All right, coronal, sagittal, and axial.
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And really this is just so that the
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technologists can check their positioning
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and then prescribe the slices.
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And.
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Even though we'd like to ignore these
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images, we are still responsible for them.
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So, I do look at those first, just to make
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sure that there isn't some problem outside
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of the breast that should be reported.
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This is our T1 sequence.
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And just starting from the top,
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it's going to move this up a little bit.
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You can see the pectoralis major muscle
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here and minor behind it, and a little bit
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Level one lymph nodes coming into view here,
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more lymph nodes.
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And then as we move down, we're
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getting into breast tissue.
1:46
Those cysts that we looked
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at before, here are the cysts.
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This is at the nipple level.
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So, nipples are relatively symmetrically
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positioned in this patient.
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Kind of coming all the way through
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to the bottom of the breast.
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So, we do want to include from the
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top to the bottom of the breast.
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Let's see that that's all included here.
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We have a good field of view.
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We're seeing our lymph nodes
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and muscular structures.
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Then the next sequence is our STIR.
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And again, taking that from the top, we
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can see that our lymph nodes are
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bright on STIR, as our blood vessels
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and fatty tissue and muscular
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tissue are going to be darker.
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All of our cysts are going to be bright.
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But not everything that's bright
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on STIR is a cyst, because other
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masses can be bright also.
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You can see plenty of cysts in this patient.
3:01
Then we come over to our
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T1
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weighted sequence with fat saturation.
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And sometimes fat saturation can
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be a real challenge in MR,
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especially at higher field strength.
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But you can see in this case
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that fat is reasonably uniformly
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saturated and dark in color.
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And in this, this patient has a little
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bit of that T1 hyperintense signal
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within subareolar or retroareolar ducts.
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You can see them here and here.
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And as I scroll through, you can see that
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they are linear and branching structures,
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in this case going almost all the way to
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the back of the breast tissue, but those
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are ducts containing proteinaceous fluid.
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Then we give contrast.
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This is our first post-contrast sequence.
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We can see that our lymph nodes are now
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enhancing, our blood vessels are enhancing,
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and our breast tissue starts to enhance.
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So, we can see lots of little dots
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here within the tissue and
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the breast tissue is enhancing.
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We also get a nice look at our internal
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mammary artery and vein here on both sides.
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And that's where we would be looking for
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lymphadenopathy.
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And then our post-contrast sequence.
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Basically, everything that's
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showing up is enhancing, a lot of
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background enhancement in this patient.
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Lots of little foci scattered throughout.
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Okay.
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And then there'd be two
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more sequences like that.
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And then, then the myth, and
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sometimes we can get this to tumble.
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Here's the tumbling myth.
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So, you can just move this around, we'll
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usually also have one that rotates from right
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to left, but this one tumbles and sometimes
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that helps you in terms of looking at whether
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something is a vessel versus linear non-
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mass enhancement, but that's the tumbling.
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