0:01

So our next case for background parenchymal

0:03

enhancement is a 37 year old woman who was seen for high risk screening.

0:08

And the images that I'm going to show you are from her baseline MRI. Okay,

0:15

so we can see on the T1 non-fat saturated images that the patient has

0:21

heterogeneous or extreme fibroglandular tissue, lots of tissue,

0:27

and then her enhancement pattern is a little bit unusual.

0:34

So as we come from the superior portion of the breast tissue

0:41

and go downward, we see this sort of regional non mass enhancement.

0:49

And in some places, it almost looks like it

0:53

goes along the outer edge of the tissue. Almost like a frame.

0:58

And we do refer to this as a picture frame

1:00

enhancement, which is pretty typical of background parenchymal enhancement.

1:05

As we continue down,

1:08

there's part of the middle of the tissue that doesn't really enhance.

1:16

And then the inferior tissue also enhances, and all the way down to the bottom.

1:24

And this is quite asymmetric compared to the other side.

1:27

There's a little bit of enhancement,

1:29

some patchy areas of enhancement, but there's much less on the other side.

1:34

So we were a little unsure about this.

1:36

We thought that this was probably her background.

1:40

It was a baseline exam.

1:42

There was nothing particularly suspicious about this.

1:45

And we decided to follow this in six months.

1:50

So here's our example of background

1:53

parenchymal enhancement that we just talked about, where we had asymmetric background

2:00

enhancement on the right side compared to the left.

2:03

And the pattern was a little bit unusual,

2:05

and we decided to do a six month follow up.

2:08

So on the left side of your screen is our original baseline MRI.

2:13

And on the right side of the screen, we have our six month follow up.

2:17

So just to show you what has happened

2:19

in six months, starting from the top,

2:27

background has gone down substantially.

2:32

And all of that background that we were

2:34

seeing on the right side has essentially resolved.

2:39

There's a little bit of that picture frame type background enhancement here.

2:44

We're at the level of the nipple on both of these images.

2:47

You can see all this background here. On the left side of your screen

2:52

and on the right side, it has essentially resolved.

2:55

So this was all background parenchymal

3:00

enhancement. We can see on the other side as well.

3:03

It was a little bit of background here in the posterior breast,

3:10

especially the lower posterior breast, where it looked like there were some focal

3:15

areas or patchy areas of enhancement along the back of the breast tissue.

3:21

And that has essentially resolved on follow up.

3:26

So we thought we were in good shape.

3:28

We called this a BI-RADS 2, or even a BI-RADS 1,

3:34

and we followed up again at the time

3:37

of our next high risk screening exam, which was a year later.

3:43

I wanted to show you that one.

3:46

And now the left side has that intermediate study where everything

3:51

looked better and then we see her again in a year.

3:58

So at this point, what has happened

4:01

is that she changed her background pattern again.

4:07

So this is not typical, but sometimes, especially in our younger patients who

4:13

are having hormonal cycles, we can see something like this.

4:17

So we went from a lot of background

4:19

on the right side to no background at all in the middle study.

4:24

And then on this one, we have some linear

4:30

enhancement here, and then some enhancement

4:35

forming in the middle, here on the left

4:42

and sort of down here at the bottom.

4:47

And we again developed that background

4:50

enhancement along the posterior edge on the left.

4:54

So at this point, my colleague,

4:58

who was reading this exam was not really comfortable continuing to call this

5:03

background and ended up doing MRI-guided biopsy on each side.

5:08

And what we got was benign breast tissue

5:11

with fibrocystic change and some other benign findings.

5:14

But essentially, the thought was this was just changing background over time.

5:20

So, very interesting case in a young woman.