0:01

So our next group of cases was characterized as BI-RADS 5.

0:06

We'll go through these one by one.

0:08

So our first case is a 50 year old woman with an outside mammogram and ultrasound

0:14

showing a suspicious mass in the left breast.

0:17

And this had not yet been biopsied,

0:19

so we didn't have biopsy proof of what this was.

0:24

An MRI was requested for further evaluation.

0:29

I think there was some delay getting the biopsy done.

0:32

So in the meantime, they did an MRI.

0:34

So here's her MRI, and we'll start with the MIP.

0:40

And the MIP image shows moderate background enhancement,

0:44

which is really characterized by scattered foci of enhancement.

0:48

These sort of similar appearing foci bilaterally.

0:51

And then there's an enhancing mass here

0:54

in the left posterior breast, kind of suspicious looking.

1:00

So we will go and take a look at some of these other sequences.

1:05

So I'm just going to pull in our usual

1:07

friends, the T1-weighted non-fat saturated sequence and the first post contrast subs,

1:15

and just take a look at this.

1:18

So if we start from the top, we can see that there's a very large lymph

1:24

node in the left axilla, which is abnormal.

1:30

And then as we scroll down, we get into this mass,

1:36

that's homogeneously enhancing, irregular, and that is suspicious.

1:43

So that will need a biopsy.

1:45

This patient had had previous surgery on the right side.

1:50

So you can see that over here, sort of distortion,

1:52

but without enhancement.

1:58

Just going down through her breast tissue.

2:01

So there are some other areas of enhancement.

2:07

There's sort of an elongated oval mass here and there's some linear non mass

2:14

enhancement here on the left side, really quite discreet from the rest

2:22

of the tissue.

2:30

And then back into that mass again.

2:33

Everything else looks like foci.

2:36

So, I think the first step

2:41

is going to be to recommend a second look ultrasound and biopsy of the abnormal

2:49

looking lymph node and the mass in the left upper outer posterior breast.

2:58

And then furthermore, one could consider

3:03

biopsy of this linear non mass, which is quite a distance away,

3:08

and then consider evaluation of this oval mass in the right breast.

3:15

And if I remember correctly, the oval mass was stable mammographically

3:21

for several years, but this hadn't been seen before.

3:24

So the linear non mass was biopsied using MRI guidance and that was benign.

3:31

So the patient was able to have treatment

3:34

for this area, which was a cancer, diagnosed by ultrasound-guided biopsy.

3:40

And the lymph node did demonstrate metastatic disease.

3:46

And our other sequences basically show similar findings.

3:52

These are our source images.

3:56

Sometimes the additional imaging gives you a little bit more information.

4:00

And the second and third post contrast series, we're usually, you know,

4:06

using them for sort of confirmation and for kinetic information.

4:10

But our best source of information is

4:14

usually going to be this first post contrast sequence and in comparison

4:20

to the precontrast, which essentially gives you the subtraction images.

4:26

Okay.

4:27

And that's pre and post contrast imaging of that mass.