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Radiology
Breast Magnetic Resonance Imaging
Built from Fundamentals of Diagnostic Radiology
What’s inside
5 sections · 122 slides
Overview
- What breast MRI covers
Introduction and Indications
Screening, extent of disease, and implant evaluation
- Mammography's limits
- What contrast-enhanced breast MR adds
- Indications for breast MRI
- Indications for contrast-enhanced breast MR
- High-risk screening guidelines
- Who counts as high risk
- ACR appropriateness rating scale
- Risk categories on the ACR scale
- How much better MR detects cancer
- Sensitivity, specificity, NPV, and PPV of breast MR
- MR sensitivity is not blocked by density
- Screening-detected invasive ductal cancer
- Annual screening finds new cancers
- New cancer on annual screening MR
- Intermediate-risk women
- Personal history of breast cancer
- Breast MR after bilateral lumpectomy
- Breast-conserving therapy and recurrence
- Internal mammary nodes
- Internal mammary node metastasis
- Finding additional sites of disease
- Multicentric breast cancer
- Who benefits most from preoperative MR
- Invasive lobular carcinoma
- Invasive lobular carcinoma on MR
- MR finds contralateral disease
- Contralateral occult disease
- Surgical impact is variable
- Extramammary findings on breast MR
- Where breast cancer metastasizes
- Incidental extramammary findings
- Chest wall and muscle invasion
- Edema versus true muscle invasion
- Tumor extension into pectoralis muscle
- Positive margins after lumpectomy
- Neoadjuvant chemotherapy monitoring
- Axillary metastasis with unknown primary
- How MR locates the hidden primary
- Axillary metastasis with unknown primary
- Nipple discharge
- When MR helps with nipple discharge
- Nipple discharge after failed galactogram
- Biopsy planning
- Implant rupture evaluation
- Two types of silicone rupture
- Rupture type at a glance
- Silicone implant rupture
- Silicone implant technique notes
- Peri-implant fluid collections
- Breast implant-associated ALCL
- Breast implant-associated ALCL
Technique
Imaging parameters, kinetics, and artifacts
- ACR accreditation requirements
- ACR technical guidelines for breast MR
- Positioning and coil
- Core pulse sequences
- Information from MR pulse sequences
- Why cancers enhance early
- Three kinetic curves
- Which curve worries us most
- Breast MR kinetic curves
- Computer-aided diagnosis
- Enhancement curves on dynamic breast MR
- Sources of artifacts
- Fat saturation
- Motion and phase-encoding
- Common artifacts on breast MR
- Common artifacts on breast MR (continued)
Interpretation
Background enhancement, fibroglandular tissue, and the three findings
- How the BI-RADS lexicon grew
- What an MR report includes
- Background parenchymal enhancement
- Background parenchymal enhancement categories
- Background parenchymal enhancement levels
- BPE and cancer risk
- Hormones and timing
- Fibroglandular tissue amount
- Fibroglandular tissue categories
- Amount of fibroglandular tissue
- Three finding types
- Breast MRI lexicon of findings
- What a focus is
- Focus on breast MR
- Focus: benign versus malignant clues
- Differential diagnosis of a focus
- What a mass is
- Concerning mass features
- Mass margins: spiculated vs circumscribed
- Predicting cancer subtype
- Benign masses
- Fibroadenoma on breast MR
- What nonmass enhancement is
- NME distribution
- NME internal enhancement
- Nonmass enhancement patterns
- Differential diagnosis of NME
Workup, Risks, and Future
Abnormal findings, contrast safety, and abbreviated protocols
- Workup of an abnormal MRI
- Finding a correlate
- Confirm the target
- No radiation, but contrast carries risk
- Nephrogenic systemic fibrosis
- Gadolinium deposition
- Breast MR contrast agents
- Contrast agent types
- Why an abbreviated protocol
- The abbreviated MR protocol
- Abbreviated protocol trade-offs
- Ongoing work
- Conclusion
- References
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- References (continued)
- Brant and Helms' Fundamentals of Diagnostic Radiology