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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.
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Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
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Musculoskeletal Imaging
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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.
Practice Cases
Worklist 1
10 topics, 31 min.
Practice Cases
Worklist 2
10 topics, 50 min.
Practice Cases
Worklist 3
10 topics, 38 min.
Practice Cases
Worklist 4
10 topics, 18 min.
Practice Cases
Worklist 5
10 topics, 29 min.
0:00
So this case is a little different, but a good,
0:03
I think, reminder to think about technique and
0:07
quality when you're looking at MRI exams, right?
0:11
So, you know, same issues apply in
0:14
terms of positioning of the breast.
0:19
Um, you know, and we certainly have seen and you
0:24
will see a few cases of this more in the
0:27
course later, but we have certainly seen many
0:30
cases of poor positioning on MRI, which can lead
0:34
us astray, right? Either in visualization or
0:38
gives you some artifact that makes it impossible
0:40
to, you know, visualize a portion of the breast,
0:44
um, or, you know, could even create things that
0:45
look like masses that aren't, um, so, um,
0:49
in this case, of course, positioning is good.
0:51
But the issue that came up is that,
0:56
um, we didn't actually get any
0:59
sort of contrast in the patient.
1:01
So this, sorry to rotate that one.
1:06
Um, we have the pre and Thanks.
1:10
Post contrast images here.
1:12
Um, and they look, you know,
1:14
exactly the same, right?
1:15
We really don't see any contrast in the heart.
1:17
We should be seeing quite a bit in the
1:19
heart, and we don't see really any at all.
1:22
So this is, uh, kind of a
1:23
failed contrast administration.
1:25
And, of course, this patient, um,
1:28
has not had an adequate study.
1:30
Um, and it needs to return
1:32
for a repeat, repeat study.
1:33
And really, this sort of thing should
1:34
be caught by your technologists.
1:37
Um, but if they don't, uh, you're
1:38
the last, last stop for that.
1:39
And you can bring that up.
1:44
So nothing really, nothing really
1:45
to see there in the breast.
1:46
I mean, I guess they did have a couple of
1:47
little findings here, probably some, uh,
1:49
cysts that are, uh, have some either blood
1:52
or proteinaceous debris in them.
1:55
I'm giving a little bit of T1 signal there.
1:57
Um, but nothing else to see there,
1:59
nothing else that we can see, because
2:01
we don't have any contrast on board.
Wk 1, Case 5 - Review
HIDEInteractive Transcript
0:00
So this case is a little different, but a good,
0:03
I think, reminder to think about technique and
0:07
quality when you're looking at MRI exams, right?
0:11
So, you know, same issues apply in
0:14
terms of positioning of the breast.
0:19
Um, you know, and we certainly have seen and you
0:24
will see a few cases of this more in the
0:27
course later, but we have certainly seen many
0:30
cases of poor positioning on MRI, which can lead
0:34
us astray, right? Either in visualization or
0:38
gives you some artifact that makes it impossible
0:40
to, you know, visualize a portion of the breast,
0:44
um, or, you know, could even create things that
0:45
look like masses that aren't, um, so, um,
0:49
in this case, of course, positioning is good.
0:51
But the issue that came up is that,
0:56
um, we didn't actually get any
0:59
sort of contrast in the patient.
1:01
So this, sorry to rotate that one.
1:06
Um, we have the pre and Thanks.
1:10
Post contrast images here.
1:12
Um, and they look, you know,
1:14
exactly the same, right?
1:15
We really don't see any contrast in the heart.
1:17
We should be seeing quite a bit in the
1:19
heart, and we don't see really any at all.
1:22
So this is, uh, kind of a
1:23
failed contrast administration.
1:25
And, of course, this patient, um,
1:28
has not had an adequate study.
1:30
Um, and it needs to return
1:32
for a repeat, repeat study.
1:33
And really, this sort of thing should
1:34
be caught by your technologists.
1:37
Um, but if they don't, uh, you're
1:38
the last, last stop for that.
1:39
And you can bring that up.
1:44
So nothing really, nothing really
1:45
to see there in the breast.
1:46
I mean, I guess they did have a couple of
1:47
little findings here, probably some, uh,
1:49
cysts that are, uh, have some either blood
1:52
or proteinaceous debris in them.
1:55
I'm giving a little bit of T1 signal there.
1:57
Um, but nothing else to see there,
1:59
nothing else that we can see, because
2:01
we don't have any contrast on board.
Report
HISTORY:
44-year-old woman presenting with a palpable right breast mass. US guided biopsy of mass showed invasive ductal carcinoma ER+ PR+ Heu2+. Right axillary node biopsy was negative.
Summary of prior imaging:
Mammography: Extremely dense breasts with ill-defined 4cm mass RUOQ Ultrasound: 3.5 cm lobulated vascular hypoechoic mass 11:30 4cm FN. 2 cm right axillary node with thickened cortex.
Breast MRI: NA
FINDINGS
Quality control issues: ☐None ☒Poor/lack contrast bolus ☐Poor fat suppression
☐ Susceptibility ☐Movement ☐Other: Click or tap here to enter text.
Background Parenchymal Enhancement: Minimal
Amount of Fibroglandular Tissue: Extreme fibroglandular tissue
LEFT BREAST
Narrative: Multiple cysts, no enhancing lesions
Associated findings LEFT breast: ☐Nipple retraction, ☐Nipple involvement, ☐Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,
☐ Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion
Non-enhancing findings LEFT breast: ☐High ductal signal pre contrast T1, ☒Cyst(s),
☐ Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☐Non-enhancing mass,
☐ Architectural distortion, ☐Signal void from clips
Fat containing lesions LEFT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat
Lymph nodes LEFT: ☒Normal axillary, ☐Abnormal axillary: description, ☐ Abnormal internal mammary: description
RIGHT BREAST
Narrative: Lack of intravenous contrast negates evaluation of this study. Known IDC is seen as 3.5 cm “non enhancing” mass with peripheral clip artifact. Multiple cysts
Right breast lesion 1
Lesion type: Mass
3.5 cm. Upper outer Quadrant. 11:00 Radian. 4 cm from the nipple
Mass/post-surgical change: Shape:Oval/lobulated. Margins:Circumscribed , Enhancement
cannot be evaluated.
BI-RADS:6: Known biopsy-proven malignancy – Appropriate action should be taken
Associated findings RIGHT breast: ☐Nipple retraction, ☐Nipple involvement, ☐Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,
☐ Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion
Non-enhancing findings RIGHT breast: ☐High ductal signal pre contrast T1, ☒Cyst(s),
☐ Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☒Non-enhancing mass,
☐ Architectural distortion, ☒Signal void from clips
Fat containing lesions RIGHT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat
Lymph nodes RIGHT: ☐Normal axillary, ☒Abnormal axillary: At least 2 mildly abnormal nodes, largest 16 mm with a clip artifact, ☐ Abnormal internal mammary: description
Extramammary findings: None
SUMMARY: Failed contrast bolus. Known 3.5 cm Right IDC does not therefore enhance
RECOMMENDATIONS: Repeat study as soon as possible
Case Discussion
Faculty
Petra J Lewis, MBBS
Professor of Radiology and OBGYN
Dartmouth-Hitchcock Medical Center & Geisel School of Medicine at Dartmouth
Sheryl G. Jordan, MD
Professor, Department of Radiology
University of North Carolina School of Medicine
Ryan W. Woods, MD, MPH
Assistant Professor of Radiology
University of Wisconsin School of Medicine and Public Health
Tags
Women's Health
MRI
Breast
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