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.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
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.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
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.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
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.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 2 min.
2 topics, 5 min.
5 topics, 33 min.
3 topics, 14 min.
8 topics, 28 min.
4 topics, 20 min.
4 topics, 25 min.
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, our next patient is a 50-year-old
0:04
woman with a large left lymph
0:07
node seen on screening mammogram.
0:09
So, compared to prior mammograms, this
0:11
lymph node became larger over time, and
0:14
she was recalled for axillary ultrasound.
0:17
She subsequently had a biopsy that showed
0:19
metastatic breast carcinoma, and her
0:22
mammography was negative, and MRI was
0:25
performed to find the primary tumor.
0:29
And this is the patient's MIP.
0:30
A lot of blood vessels, which are
0:33
kind of obscuring some of the tissue.
0:36
So we're just going to
0:37
look at images separately.
0:44
And here's T1-weighted images and
0:47
post-contrast subtraction images.
0:51
And we can see up here in the left axilla,
0:56
there's a big lymph node here with a
0:59
susceptibility artifact from a biopsy clip.
1:02
So that was the biopsy lymph node
1:04
showing metastatic carcinoma.
1:07
There's a second smaller, but still abnormal
1:11
lymph node anterior and inferior to this.
1:15
So she does not have
1:20
very dense tissue.
1:21
She has scattered fibroglandular tissue.
1:25
And one would think that with this
1:28
kind of tissue, we'd really be able
1:29
to see breast cancer pretty easily,
1:33
but that wasn't the case. Her mammogram
1:35
looked normal and similar to prior exams.
1:39
So, we basically went through very
1:42
carefully, looking at everything.
1:44
She has a few foci of enhancement,
1:46
but what we did see was
1:50
one spot that was a little bit
1:52
more prominent on the left side.
1:57
And it's right here.
2:00
So left anterior breast, small mass. I think
2:04
it was eight by four millimeters. You know,
2:08
really one that you could pass by
2:11
pretty quickly, but that stood out to us.
2:18
And I think even going back, looking at
2:21
her MRI, even though there are lots of
2:24
blood vessels, you can still see that
2:26
little spot maybe stands out a little bit.
2:31
And we looked at her pre- and post-images,
2:36
and there's that little mass again.
2:40
And we recommended that for biopsy
2:43
because it was the only thing that
2:43
really stood out as being different.
2:45
And that was an invasive ductal carcinoma.
2:49
So that was the source of
2:51
her metastatic lymph node.
2:54
And again, this was coded as a BI-RADS 4.
Interactive Transcript
0:01
So, our next patient is a 50-year-old
0:04
woman with a large left lymph
0:07
node seen on screening mammogram.
0:09
So, compared to prior mammograms, this
0:11
lymph node became larger over time, and
0:14
she was recalled for axillary ultrasound.
0:17
She subsequently had a biopsy that showed
0:19
metastatic breast carcinoma, and her
0:22
mammography was negative, and MRI was
0:25
performed to find the primary tumor.
0:29
And this is the patient's MIP.
0:30
A lot of blood vessels, which are
0:33
kind of obscuring some of the tissue.
0:36
So we're just going to
0:37
look at images separately.
0:44
And here's T1-weighted images and
0:47
post-contrast subtraction images.
0:51
And we can see up here in the left axilla,
0:56
there's a big lymph node here with a
0:59
susceptibility artifact from a biopsy clip.
1:02
So that was the biopsy lymph node
1:04
showing metastatic carcinoma.
1:07
There's a second smaller, but still abnormal
1:11
lymph node anterior and inferior to this.
1:15
So she does not have
1:20
very dense tissue.
1:21
She has scattered fibroglandular tissue.
1:25
And one would think that with this
1:28
kind of tissue, we'd really be able
1:29
to see breast cancer pretty easily,
1:33
but that wasn't the case. Her mammogram
1:35
looked normal and similar to prior exams.
1:39
So, we basically went through very
1:42
carefully, looking at everything.
1:44
She has a few foci of enhancement,
1:46
but what we did see was
1:50
one spot that was a little bit
1:52
more prominent on the left side.
1:57
And it's right here.
2:00
So left anterior breast, small mass. I think
2:04
it was eight by four millimeters. You know,
2:08
really one that you could pass by
2:11
pretty quickly, but that stood out to us.
2:18
And I think even going back, looking at
2:21
her MRI, even though there are lots of
2:24
blood vessels, you can still see that
2:26
little spot maybe stands out a little bit.
2:31
And we looked at her pre- and post-images,
2:36
and there's that little mass again.
2:40
And we recommended that for biopsy
2:43
because it was the only thing that
2:43
really stood out as being different.
2:45
And that was an invasive ductal carcinoma.
2:49
So that was the source of
2:51
her metastatic lymph node.
2:54
And again, this was coded as a BI-RADS 4.
Report
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
MRI
Breast
© 2025 Medality. All Rights Reserved.