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Training Collections
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On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
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Ultimate Learning Pass
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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, 3 min.
1 topic, 7 min.
6 topics, 21 min.
9 topics, 19 min.
Circumscribed Mass – Intramammary Lymph Node
2 m.Circumscribed Mass – Fibroadenoma
2 m.Increasing Oval Circumscribed Mass on Ultrasound
2 m.Breast Clustered Microcyst
2 m.Complicated Breast Cyst
2 m.Complicated Cyst that Resolved on Ultrasound
2 m.Axillary Adenopathy Post Covid Vaccine
3 m.Evolving Fat Necrosis (Post Breast Reduction)
2 m.BI-RADS 3 Indications on Ultrasound – Summary
7 m.7 topics, 19 min.
Circumscribed Breast Fibroadenoma on MRI
6 m.Dominant Focus on Breast MRI without T2 Hyperintensity
3 m.Enhancing Dominant/Unique Focus on Breast MRI - Companion Case
2 m.Focal NME (Non-Mass Enhancement) on Breast MRI
3 m.Fat Necrosis on Breast MRI
2 m.BI-RADS 3 Indications on MRI – Summary
5 m.BI-RADS 3 – Conclusion
2 m.0:01
This is a high risk screening MRI. And again, this is the,
0:04
I like to kind of start by looking at the myth image to see if
0:06
anything stands out. And right away on this myth image,
0:10
we see this focus in the outer right breast. It sort of stands out.
0:15
It's a little bit brighter than her other kind of scattered
0:18
foci around the breast. She does have other enhancing foci throughout both
0:23
breasts, but this one looks a little bit bigger and a little bit
0:25
brighter, which stands out to us. Then we can look at the
0:30
post contrast and find that focus. And here it is in the lower
0:42
outer right breast, anterior depth. It's a dominant focus.
0:51
The next thing we want to do is similar to our last cases.
0:54
We want to see if there is a T2 correlate. And in this
0:58
case, there was not. So here we are sort of matched up on
1:03
the slices and we're not seeing anything that's T2 right at that site.
1:09
This is another finding that is appropriate for BI RADS 3 is a
1:14
dominant or a unique enhancing focus, which does not have a T2 correlate.
1:22
This actually, our institution was biopsied and was benign.
1:29
We don't have the kinetics on this case, but if there's mixed feelings on
1:33
whether the kinetics are actually helpful for enhancing foci because they're
1:37
so small, but as is would be expected, if we're seeing persistent kinetics,
1:43
that would be a reassuring sign. And if we saw washout kinetics, that
1:49
would be more suspicious. And I think with this, if there was
1:54
suspicious kinetics, I would have a low threshold to do an MRI biopsy
1:58
instead of following. But like I mentioned before, this is kind of an
2:03
evolving topic and the recommendation to follow an enhancing focus without
2:10
a T2 correlate is really based on expert opinion.
2:14
The studies have been sort of back and forth on
2:17
whether there is truly a less than 2% chance of malignancy, but it's
2:22
clear that there's at least a very low chance of malignancy for this
2:25
finding. And a six month follow up is a reasonable recommendation.
Interactive Transcript
0:01
This is a high risk screening MRI. And again, this is the,
0:04
I like to kind of start by looking at the myth image to see if
0:06
anything stands out. And right away on this myth image,
0:10
we see this focus in the outer right breast. It sort of stands out.
0:15
It's a little bit brighter than her other kind of scattered
0:18
foci around the breast. She does have other enhancing foci throughout both
0:23
breasts, but this one looks a little bit bigger and a little bit
0:25
brighter, which stands out to us. Then we can look at the
0:30
post contrast and find that focus. And here it is in the lower
0:42
outer right breast, anterior depth. It's a dominant focus.
0:51
The next thing we want to do is similar to our last cases.
0:54
We want to see if there is a T2 correlate. And in this
0:58
case, there was not. So here we are sort of matched up on
1:03
the slices and we're not seeing anything that's T2 right at that site.
1:09
This is another finding that is appropriate for BI RADS 3 is a
1:14
dominant or a unique enhancing focus, which does not have a T2 correlate.
1:22
This actually, our institution was biopsied and was benign.
1:29
We don't have the kinetics on this case, but if there's mixed feelings on
1:33
whether the kinetics are actually helpful for enhancing foci because they're
1:37
so small, but as is would be expected, if we're seeing persistent kinetics,
1:43
that would be a reassuring sign. And if we saw washout kinetics, that
1:49
would be more suspicious. And I think with this, if there was
1:54
suspicious kinetics, I would have a low threshold to do an MRI biopsy
1:58
instead of following. But like I mentioned before, this is kind of an
2:03
evolving topic and the recommendation to follow an enhancing focus without
2:10
a T2 correlate is really based on expert opinion.
2:14
The studies have been sort of back and forth on
2:17
whether there is truly a less than 2% chance of malignancy, but it's
2:22
clear that there's at least a very low chance of malignancy for this
2:25
finding. And a six month follow up is a reasonable recommendation.
Report
Description
Faculty
Emily B. Ambinder, MD
Assistant Professor - Breast Imaging Division
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine
Tags
Women's Health
Neoplastic
MRI
Breast
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