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Changing BPE Over 3 Time Points

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So our next case for background parenchymal

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enhancement is a 37 year old woman who was seen for high risk screening.

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And the images that I'm going to show you are from her baseline MRI. Okay,

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so we can see on the T1 non-fat saturated images that the patient has

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heterogeneous or extreme fibroglandular tissue, lots of tissue,

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and then her enhancement pattern is a little bit unusual.

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So as we come from the superior portion of the breast tissue

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and go downward, we see this sort of regional non mass enhancement.

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And in some places, it almost looks like it

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goes along the outer edge of the tissue. Almost like a frame.

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And we do refer to this as a picture frame

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enhancement, which is pretty typical of background parenchymal enhancement.

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As we continue down,

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there's part of the middle of the tissue that doesn't really enhance.

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And then the inferior tissue also enhances, and all the way down to the bottom.

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And this is quite asymmetric compared to the other side.

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There's a little bit of enhancement,

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some patchy areas of enhancement, but there's much less on the other side.

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So we were a little unsure about this.

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We thought that this was probably her background.

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It was a baseline exam.

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There was nothing particularly suspicious about this.

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And we decided to follow this in six months.

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So here's our example of background

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parenchymal enhancement that we just talked about, where we had asymmetric background

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enhancement on the right side compared to the left.

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And the pattern was a little bit unusual,

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and we decided to do a six month follow up.

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So on the left side of your screen is our original baseline MRI.

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And on the right side of the screen, we have our six month follow up.

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So just to show you what has happened

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in six months, starting from the top,

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background has gone down substantially.

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And all of that background that we were

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seeing on the right side has essentially resolved.

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There's a little bit of that picture frame type background enhancement here.

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We're at the level of the nipple on both of these images.

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You can see all this background here. On the left side of your screen

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and on the right side, it has essentially resolved.

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So this was all background parenchymal

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enhancement. We can see on the other side as well.

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It was a little bit of background here in the posterior breast,

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especially the lower posterior breast, where it looked like there were some focal

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areas or patchy areas of enhancement along the back of the breast tissue.

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And that has essentially resolved on follow up.

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So we thought we were in good shape.

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We called this a BI-RADS 2, or even a BI-RADS 1,

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and we followed up again at the time

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of our next high risk screening exam, which was a year later.

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I wanted to show you that one.

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And now the left side has that intermediate study where everything

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looked better and then we see her again in a year.

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So at this point, what has happened

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is that she changed her background pattern again.

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So this is not typical, but sometimes, especially in our younger patients who

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are having hormonal cycles, we can see something like this.

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So we went from a lot of background

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on the right side to no background at all in the middle study.

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And then on this one, we have some linear

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enhancement here, and then some enhancement

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forming in the middle, here on the left

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and sort of down here at the bottom.

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And we again developed that background

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enhancement along the posterior edge on the left.

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So at this point, my colleague,

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who was reading this exam was not really comfortable continuing to call this

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background and ended up doing MRI-guided biopsy on each side.

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And what we got was benign breast tissue

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with fibrocystic change and some other benign findings.

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But essentially, the thought was this was just changing background over time.

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So, very interesting case in a young woman.

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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