0:01

Our next group is BI-RADS 3 cases.

0:05

And our first case is a 60-year-old

0:07

woman seen for high-risk screening.

0:10

She has a history of right breast

0:12

cancer 10 years ago, and a strong

0:14

family history of breast cancer.

0:17

And this is her MRI exam.

0:20

You can see that she has some background

0:22

enhancements, some blood vessels,

0:25

and there's a little bright focus of

0:27

enhancement here in the left breast.

0:31

So we're going to go back and

0:34

investigate a little bit more.

0:36

So here's a T1 non-FATSAT

0:39

and our subtracted images.

0:44

So we can see that she has

0:49

some areas; she looks kind of heterogeneous,

0:51

and others, she looks sort of scattered

0:53

fibroglandular, so probably heterogeneous tissue.

0:59

21 00:01:00,285 --> 00:01:02,285 We can see on her T1 that

1:02

she has had a lumpectomy.

1:05

You can see scarring here in the right

1:09

upper breast, with multiple surgical

1:12

clips, with a susceptibility artifact.

1:18

So that right side has had surgery.

1:22

On the left side, the only thing

1:24

that we're seeing is this focus.

1:26

Well, she does have some other foci,

1:29

but this one really stands out as being unique.

1:34

She does have some scattered findings,

1:35

but that one is really standing out.

1:38

Okay.

1:39

So then we would look at prior images

1:43

because we'd want to know whether

1:45

that was new or old and we're just

1:49

going through other series as well.

1:52

This is T1

1:57

with fat saturation before and after

1:59

contrast, and we find that we can see

2:03

that little focus lighting up there.

2:06

And when we went to the prior

2:08

images, that was not present.

2:10

And in this case, we did a biopsy,

2:12

which was benign, but if this were the

2:16

patient's baseline exam, you know, one

2:20

could imagine that this unique focus could

2:23

be followed as a six-month follow-up.

2:27

And even if it were T2 hypointense.

2:31

So I think that the message here is that it

2:35

kind of depends on the setting, you know,

2:37

in this case we had a patient who had had

2:39

multiple prior exams and this was a

2:42

new finding, and therefore warranted biopsy.

2:47

If this were a baseline exam

2:49

for baseline high-risk screening exam.

2:52

This is something that we would

2:53

probably follow over time.