Interactive Transcript
0:01
So our next case for background parenchymal
0:03
enhancement is a 37 year old woman who was seen for high risk screening.
0:08
And the images that I'm going to show you are from her baseline MRI. Okay,
0:15
so we can see on the T1 non-fat saturated images that the patient has
0:21
heterogeneous or extreme fibroglandular tissue, lots of tissue,
0:27
and then her enhancement pattern is a little bit unusual.
0:34
So as we come from the superior portion of the breast tissue
0:41
and go downward, we see this sort of regional non mass enhancement.
0:49
And in some places, it almost looks like it
0:53
goes along the outer edge of the tissue. Almost like a frame.
0:58
And we do refer to this as a picture frame
1:00
enhancement, which is pretty typical of background parenchymal enhancement.
1:05
As we continue down,
1:08
there's part of the middle of the tissue that doesn't really enhance.
1:16
And then the inferior tissue also enhances, and all the way down to the bottom.
1:24
And this is quite asymmetric compared to the other side.
1:27
There's a little bit of enhancement,
1:29
some patchy areas of enhancement, but there's much less on the other side.
1:34
So we were a little unsure about this.
1:36
We thought that this was probably her background.
1:40
It was a baseline exam.
1:42
There was nothing particularly suspicious about this.
1:45
And we decided to follow this in six months.
1:50
So here's our example of background
1:53
parenchymal enhancement that we just talked about, where we had asymmetric background
2:00
enhancement on the right side compared to the left.
2:03
And the pattern was a little bit unusual,
2:05
and we decided to do a six month follow up.
2:08
So on the left side of your screen is our original baseline MRI.
2:13
And on the right side of the screen, we have our six month follow up.
2:17
So just to show you what has happened
2:19
in six months, starting from the top,
2:27
background has gone down substantially.
2:32
And all of that background that we were
2:34
seeing on the right side has essentially resolved.
2:39
There's a little bit of that picture frame type background enhancement here.
2:44
We're at the level of the nipple on both of these images.
2:47
You can see all this background here. On the left side of your screen
2:52
and on the right side, it has essentially resolved.
2:55
So this was all background parenchymal
3:00
enhancement. We can see on the other side as well.
3:03
It was a little bit of background here in the posterior breast,
3:10
especially the lower posterior breast, where it looked like there were some focal
3:15
areas or patchy areas of enhancement along the back of the breast tissue.
3:21
And that has essentially resolved on follow up.
3:26
So we thought we were in good shape.
3:28
We called this a BI-RADS 2, or even a BI-RADS 1,
3:34
and we followed up again at the time
3:37
of our next high risk screening exam, which was a year later.
3:43
I wanted to show you that one.
3:46
And now the left side has that intermediate study where everything
3:51
looked better and then we see her again in a year.
3:58
So at this point, what has happened
4:01
is that she changed her background pattern again.
4:07
So this is not typical, but sometimes, especially in our younger patients who
4:13
are having hormonal cycles, we can see something like this.
4:17
So we went from a lot of background
4:19
on the right side to no background at all in the middle study.
4:24
And then on this one, we have some linear
4:30
enhancement here, and then some enhancement
4:35
forming in the middle, here on the left
4:42
and sort of down here at the bottom.
4:47
And we again developed that background
4:50
enhancement along the posterior edge on the left.
4:54
So at this point, my colleague,
4:58
who was reading this exam was not really comfortable continuing to call this
5:03
background and ended up doing MRI-guided biopsy on each side.
5:08
And what we got was benign breast tissue
5:11
with fibrocystic change and some other benign findings.
5:14
But essentially, the thought was this was just changing background over time.
5:20
So, very interesting case in a young woman.
© 2024 MRI Online. All Rights Reserved.