Breast MR/procedures Flashcards
Indications for breast MRI (6)
Implant evaluation
axillary mets w/ unknown primary
extent of disease
assessing response to therapy
diagnostic delemma
high risk screening
- Who gets a screening MR?
- Which risk model do you use?
- People w/ lifetime risk >15-25%
People who got 20Gy of radiation to chest
- Use Tyrer Cuzickrisk model because it includes family history. The “Gail” risk model does not.
6 sequences that you use for breast MR
T2 w/ FS
T1 Pre w/ FS
T1 Post
Saggital
Subtracted
MIP
- Flaring artifact
- How to fix it
Non-uniform fat suppression when breast tissue is very close to coil elements.
This artifact is not related to fat suppression.
You have to put padding b/w the breast tissue and coil elements.
Background parenchymal enhancement
- When in cycle should you scan in order to minimize BPE
- what other factors effect it?
- Days 7-14
- Hormone therapy (should be stopped)
Serms decrease BPE
Tamoxifen rebound results in increased BPE
-lumpectomy and radiation
Does nipple enhance on Breast MR?
Yes. Enhancement is normal
Defninitition of “foci” in MR
Dot of enhancement (<5mm). Too small to characterize.
If there are many foci, then it is probably BPE
- What does it mean if mass/foci in MR is T2 bright?
- What is the one exception?
- Benign things that enhance (name 3)
- T2 bright = BR2
- Mucinous (colloid) cancer
- fibroadenoma, Papilloma, Lymph nodes
Appearance of firoadenoma on MR
Circumscribed round/oval mass
Variable on T2
On post-contrast, it can enhance, and have non-enhancing septations
If a lesion is not T2 bright, then what do you look at?
- Mass margin should be evaluated on the first post-contrast series. What border feature is most predictive of malignancy?
- Look at morphology, then kinetics
- Spiculated
- Non-mass like enhancement is classic imaging for what?
- It is described by distribution. The distribution is its most predictive feature. Which distributions are bad?
- DCIS is Classic, but it can also represent IDC
- Segmental is worst distribution. Linear, and focal distribution is bad.
BiRADS - MR lexicon
- Shape - 3
- Margins - 3
- Enchancement - 4
- Round, oval, irregular
- Circumscribed, spiculated, irregular
- Homogenous, heterogenous, rim, Dark internal septations.
BIrads - MR lexicon for NME
- Disribution - 6
- Internal enhancement - 4 - (which is the wort kind)
- Focal, segmental, linear, regional, multiple regions, diffuse
- Homogenous, heterogenous, clumped, clustered ring
Clustered ring is the worst kind.
2 types of breast implants. 2 locations.
- Saline and silicone (can’t see through silicone on Mammo)
- For Silicone, you body will form a fibrous capsule around implant. - subglandular/retromammary, subpectoral/retropectoral
- Saline -types of ruptures
- Types of silicone ruptures
appearance on Mammo, u/s and MRI
*if you see silicone in a lymph node, you need to recommend MRI to evaluate for extracapsular rupture.
- Saline - no capsule (no such thing as ‘intracapsular rupture”)
- Silicone: both intra and extra capsular rupture.
mammo: You can’t see intra on mammogram.
u/s: extracapsular creates snowstorm appearance
intracapsular creates ‘step ladder’ appearance.
MRI: intracapsular has linguine sign