Breast Imaging - MG, US, MR, IR

Question 1

What are diagnostic mammo views

Answer 1

Lateral exaggerated cranial-caudal (XCCL)
Vs medial (XCCM)

Rolled views medial or lateral (RCCM or RCCL)

True lateral - ML or LM - triangulate lesion on MLO or CC

Question 2

Name zonal anatomy of breast seen on ultrasound

Answer 2

Premammary/ subcutaneous
Mammary
Retro mammary

US:

Dermis
Premammary fat
Fibroglandular tissue
Pectoralis

Question 3

Describe breast MRI curves

Answer 3

Describes enhancement kinetics of a lesion post contrast on MRI:

Delayed phase of enhancement:

Type 1 (persistent) - continuously increasing > 10% enhancement in delayed phase after 2 mins _ 83% benign up to 9% malignant

Type 2 (plateau) - - early rise but levels of within 10%_ PPV of 64-77% - suspicious but less than type 3

Type 3 (washout) - > 10% decrease in signal intensity. PPV 87-92%. Seen only in 21% malignant lesions - false positive - lymph nodes, adenosis, papillomas

• vs early - slow, medium, rapid
  Malignant lesion expected to have rapid early enhancement and washout (due to tumour angiogenesis and resultant capillary permeability) - foundation for kinetic analysis in dynamic contrast-enhanced breast MRI