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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Pre-Course Activities
1 topic, 2 min.
Lesson
Introduction to Breast MRI
2 topics, 5 min.
Lesson
Indications and Protocol
5 topics, 33 min.
Lesson
MRI BI-RADS
3 topics, 14 min.
Lesson
Enhancing MRI Findings
8 topics, 28 min.
Lesson
Other Findings
4 topics, 20 min.
Lesson
Interpretation and Reporting
4 topics, 25 min.
Lesson
BI-RADS Case Review
22 topics, 1 hr. 17 min.
BI-RADS Assessment Categories – Overview
11 m.BI-RADS 1
5 m.BI-RADS 2 – Left Lumpectomy
4 m.BI-RADS 2 – Right Lumpectomy, Right Non-Enhancing Mass
2 m.BI-RADS 2 – Left Post Excisional Biopsy Change
3 m.BI-RADS 2 – Marked BPE, Stable
3 m.BI-RADS 2 – Bilateral Stable Findings
4 m.New focus of enhancement on a high risk patient (BI-RADS 4)
3 m.BI-RADS 3 – Changing Pattern of Background
2 m.BI-RADS 4 – Linear NME, Left Breast
4 m.BI-RADS 4 – Right Extensive DCIS, Left Dominant Focus
4 m.BI-RADS 4 – New Diagnosis Left Cancer, Focal NME left
3 m.BI-RADS 4 – New Diagnosis Right Breast Cancer, Nodes on Right
5 m.BI-RADS 4 – Left Axillary Node Metastasis, Evaluate for Breast Cancer
3 m.BI-RADS 5 – Suspicious Mass in Left Breast, Not Biopsied Yet
5 m.BI-RADS 5 – Left Breast Cancer, MRI Shows Right Cancer
5 m.BI-RADS 5 – New Diagnosis Right Cancer, Suspicious Masses in Right Breast
3 m.BI-RADS 5 – Right Inflammatory Cancer, Bilateral Nodes
4 m.BI-RADS 6 – Right Breast Cancer, No Other Findings
3 m.BI-RADS 6 – Left Breast Cancer, No Other Findings
2 m.BI-RADS 6 – Left Breast Cancer, Index Mass
4 m.BI-RADS 6 – Pre and Post Neoadjuvant Chemotherapy (NAC) for Left Breast Cancer
5 m.0:01
So I want to talk about some associated
0:03
features that we can see on MRI, and these
0:06
include things like nipple retraction, nipple
0:09
inversion, skin retraction, and skin thickening.
0:12
We may see skin invasion, where the breast
0:17
tumor directly invades the skin, or there's
0:20
inflammatory breast cancer where there's
0:23
actually metastatic disease within the skin.
0:26
We can see axillary adenopathy, pectoralis
0:29
muscle invasion, chest wall invasion,
0:32
and associated architectural distortion.
0:35
I wanted to show you a few of these features
0:38
and then we'll go over a case that has a
0:40
lot of these features associated with it.
0:43
So this is a patient
0:44
who has inflammatory breast cancer and
0:47
her breast skin is diffusely thick, and
0:52
her nipple is actually retracted here.
0:54
So the nipple, the shape of the
0:56
front of the breast is a little bit
0:57
deformed and her nipple is pulled in.
1:00
This is a patient who has a breast cancer
1:03
that's involving her pectoralis directly, almost
1:08
extending to the back of the pectoralis muscle.
1:11
So pectoralis involvement.
1:14
And here's a patient who
1:16
has a large breast cancer.
1:19
It actually extends from the skin to the
1:23
pectoralis muscle, but it doesn't stop there.
1:25
It goes to the chest wall.
1:29
So that yellow arrow is
1:30
indicating chest wall enhancement.
1:34
You can see that that's pretty diffuse.
1:37
So sometimes we'll have a request to look at
1:40
breast MRI when we have kind of a larger mass
1:43
or a fixed mass, it's already been biopsied,
1:46
we know it's a breast cancer, but we're trying
1:48
to figure out what structures are involved
1:52
and how can we help the surgery team and
1:55
treatment team better plan for treatment.
Associated Features on MRI
HIDEInteractive Transcript
0:01
So I want to talk about some associated
0:03
features that we can see on MRI, and these
0:06
include things like nipple retraction, nipple
0:09
inversion, skin retraction, and skin thickening.
0:12
We may see skin invasion, where the breast
0:17
tumor directly invades the skin, or there's
0:20
inflammatory breast cancer where there's
0:23
actually metastatic disease within the skin.
0:26
We can see axillary adenopathy, pectoralis
0:29
muscle invasion, chest wall invasion,
0:32
and associated architectural distortion.
0:35
I wanted to show you a few of these features
0:38
and then we'll go over a case that has a
0:40
lot of these features associated with it.
0:43
So this is a patient
0:44
who has inflammatory breast cancer and
0:47
her breast skin is diffusely thick, and
0:52
her nipple is actually retracted here.
0:54
So the nipple, the shape of the
0:56
front of the breast is a little bit
0:57
deformed and her nipple is pulled in.
1:00
This is a patient who has a breast cancer
1:03
that's involving her pectoralis directly, almost
1:08
extending to the back of the pectoralis muscle.
1:11
So pectoralis involvement.
1:14
And here's a patient who
1:16
has a large breast cancer.
1:19
It actually extends from the skin to the
1:23
pectoralis muscle, but it doesn't stop there.
1:25
It goes to the chest wall.
1:29
So that yellow arrow is
1:30
indicating chest wall enhancement.
1:34
You can see that that's pretty diffuse.
1:37
So sometimes we'll have a request to look at
1:40
breast MRI when we have kind of a larger mass
1:43
or a fixed mass, it's already been biopsied,
1:46
we know it's a breast cancer, but we're trying
1:48
to figure out what structures are involved
1:52
and how can we help the surgery team and
1:55
treatment team better plan for treatment.
Report
Description
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Neoplastic
MRI
Breast
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