0:01

So we're going to look at a case, and this

0:02

is a 52-year-old woman who we've been

0:05

following for a 4-millimeter focus in

0:08

the right breast, and she's also having

0:10

general bilateral high-risk screening.

0:14

So this is our patient, and on the left

0:17

side of the screen, we have our MIP.

0:18

We see lots of blood vessels and a

0:21

few scattered foci of enhancement,

0:24

maybe one peeking out here.

0:25

That's a little bit more prominent.

0:27

And we're going to look at

0:29

our first subtracted series.

0:32

It's going to start from the top here

0:40

and mostly vessels.

0:42

So far, when we get to this area, there

0:45

is one focus here that stands out as

0:48

being different from the background.

0:51

And that is the focus that we're following.

0:54

We look through, you know, of course we

0:56

would go through this image by image,

1:03

and You know, we did not see anything else.

1:07

It was just that one

1:10

focus there.

1:15

We can look at our STIR

1:18

images, which are also linked.

1:22

And you know, we were looking to see

1:25

whether this focus is T2 hyperintense,

1:28

but you can see that the entire

1:31

breast tissue is T2 hyperintense.

1:34

It's really difficult to say

1:35

whether this one little area

1:38

is actually T2 bright.

1:40

I don't think we can say that for sure.

1:44

We have a T1 sequence,

1:51

which is not really, you know, other than her

1:53

normal anatomy, is not showing us anything new.

1:58

She has had an excisional biopsy

2:00

here, and I think you see it

2:02

nicely on the T1-weighted images.

2:06

So it's in the lower outer

2:10

left breast at posterior depth.

2:12

She's had an excisional biopsy.

2:17

And then what I meant by

2:19

looking at the T1 pre and post.

2:22

So pre is on your left side of the screen,

2:25

post is on the right side of the screen.

2:28

If we go ahead and look at that from top to

2:32

bottom, you'll see areas that are enhancing.

2:36

And if we go to find that one

2:39

focus that we're following.

2:43

There it is.

2:46

So you can see that before we gave contrast,

2:49

it was not enhancing, and now it is, you know,

2:53

so that's why it shows up on the subtraction

2:55

images, and really nothing else in either breast.

2:59

So this lady has a 4-millimeter focus

3:03

of enhancement in the right breast.

3:07

And we had a few other exams.

3:12

This was initially seen a year ago on a

3:14

baseline screening, and then followed up at

3:17

six months, and it was stable at six months,

3:20

so now it's being followed again at six months,

3:23

so now it's been stable for a year, and at

3:25

this point we can go forward another year.

3:28

She'd be due for a high-risk screening in a

3:30

year, and we'll see her again and take a look at

3:33

that focus again if it's stable for two years.

3:36

That meets criteria for being benign.

3:39

So, you know, even though we'll look at her

3:41

every year and we'll take note of that focus,

3:44

we don't have to specifically follow it again.

3:47

So I just wanted to show you what the

3:49

report on this patient would look like.

3:52

And we use templated

3:53

reporting, which I'll show you.

3:55

Basically, we're going to have a

3:56

heading stating the type of exam.

3:59

We're going to have the history.

4:00

That it's a 52-year-old woman seen

4:02

for follow-up of a 4-millimeter

4:04

focus in the right central breast.

4:06

She has a history of excisional biopsy for a

4:09

typical ductal hyperplasia in the left breast.

4:11

We usually put in a comment about the last

4:14

menstrual period, where it was, whether

4:16

they're post-menopausal, post-hysterectomy,

4:19

whatever the patient has had a hysterectomy,

4:22

we state what that exam were compared,

4:26

if there were prior MRIs, we state that

4:29

as well, and then we have a technique.

4:32

Paragraph, which describes what has been

4:35

done, you know, basically patient was positioned

4:38

prone with a dedicated breast coil on a

4:41

3T scanner. Bilateral T1-weighted

4:45

axial three-dimensional images were obtained.

4:48

This was followed by fat-saturated

4:49

T2-weighted imaging.

4:51

We then obtained a three-dimensional

4:53

spoiled gradient echo volume acquisition

4:56

with fat suppression prior to and

4:58

three times sequentially following

5:00

the intravenous administration of 6.5 milliliters of,

5:02

and then, you know,

5:05

you put your contrast agent in here.

5:08

The dynamic sequence was viewed with

5:09

subtraction technique in the axial projection.

5:12

So this is part of our template, you know,

5:14

we're not dictating this all again every time.

5:18

And then we have a section for the

5:20

amount of fibroglandular tissue in

5:22

this case heterogeneous, and the

5:24

background parenchymal enhancement,

5:26

which in this case is mild.

5:27

And then we have findings for

5:29

the right and left breast.

5:30

And on the right, we have the 4-millimeter

5:32

focus that we were following.

5:34

We say which series and image we're

5:36

seeing it on, and then that it's stable

5:39

for one year and compared to this

5:42

date, that there's nothing new that's

5:44

suspicious and everything else looks good.

5:47

Left breast, we've got our

5:49

post-operative changes,

5:51

few scattered foci of

5:52

enhancement, and nothing else.

5:55

We usually make a comment about the

5:58

axillary lymph nodes, even if they're

6:01

negative, as a pertinent negative.

6:03

And then we have kinetic analysis.

6:05

You know, what kind of workstation was used,

6:07

and if there are any other findings,

6:09

this person has liver cysts,

6:11

so we mention that.

6:13

And then our impression is no change

6:15

in this focus, stable for one year,

6:18

and no new suspicious findings.

6:20

And then in our recommendation section,

6:22

we'll usually say what we're recommending

6:24

as far as the MRI, but also if the patient

6:27

is going to have some other type of breast

6:29

imaging, like if they're going to be due

6:30

for a screening mammogram in six months

6:32

or whatever, we'll put that in, usually

6:35

with the month and year that it's due.

6:37

And then, you know, for this patient follow

6:38

up bilateral breast MRI in a year, and our Bi-

6:41

Rads category is BI-RADS 3, probably benign.

6:45

We also put at the bottom of the report; it's

6:48

not here for this case, but for instance,

6:51

if we're recommending a biopsy, we'll put in

6:54

a statement about the fact that the results

6:58

and recommendations were discussed with

6:59

the patient or with the referring provider,

7:02

doctor, so and so, on this date at this time.

7:05

So we put in that, you know, the

7:07

critical finding was communicated,

7:09

and then, of course, we communicated as well.