Mammo US MRI

Question 1

Mammo:

How do you describe a mass, which feature is most reliable to assess for malignancy?

Answer 1

A lesion seen in two different projections

1. Shape: Round, oval, irregular (ROI)
2. Margin: Circumscribed, obscured, microlobulated, indistinct, spiculated (COMIS)
3. Density ( relative to breast parenchyma):
   Fat density (radiolucent), low density, equal density, high density.

Margin can distinguish benign vs malignant

Question 2

Mammo:

What types of asymmetry are there

Answer 2

Assymetry is a unilateral deposition, often called BR-0 during screening for a call back

Global asymmetry: greater volume of breast tissue than the contralateral side around one quadrants worth or more

Focal asymmetry: seen in two projections, might be a mass, needs spot compression

Developing asymmetry: either new or bigger than prior

Question 3

US:

Describe mass

Answer 3

1. Shape: Round, oval, irregular (ROI)
2. Orientation: Parallel (wider than tall), not - parallel (taller than wide)
3. Margin: Circumscribed, indistinct, angular, microlobulated, spiculated.
4. Echo pattern: anechoic, hyperechoic, hypoechoic, isoechoic, complex (cystic/ solid)
5. Posterior features: None, enhancement, shadowing

Question 4

Which imaging modality and sequence can show background parenchymal enhancement

Answer 4

MRI; The first post contrast sequence can show this. It can be classified as:
None, minimal, mild, moderate and marked

Question 5

Describe lesion analysis categories in MRI

Answer 5

1. Foci < 5 mm; too small to describe characteristics
2. Mass > 5mm; describe: shape, margin, internal enhancement & T2
3. Non mass enhancement: distribution, internal enhancement and T2.

Question 6

How do you describe a mass on MRI

Which words cannot be used to describe shape/ margin/ internal enhancement pattern

Answer 6

1. Shape: ROI, LOBULATED has been REMOVED from lexicon- do not pick that
2. Margin: Circumscribed, irregular, spiculated. SMOOTH has been REMOVED from lexicon- do not pick that
3. Internal enhancement pattern: Homogeneous, heterogeneous, rim and dark internal septations (think of your dark internal blackheads)

ENHANCING INTERNAL SEPTATIONS and CENTRAL ENHANCEMENT are NOT terms used anymore

Question 7

What does hyperintense T2 signal mean

Answer 7

Greater than parenchyma on T2
Greater than or equal to fat on T2
Greater than or equal to water (on T2 fat sat)

Question 8

How can you describe NME distribution

Answer 8

Focal, linear, segmental, triangle shaped, pointing towards nipple- suggestive of duct), regional (large area- not a duct), multiple regions (two or more regions) and diffuse

Question 9

How can you describe NME internal enhancement

Answer 9

Homogeneous, heterogeneous, clumped (looks like cobblestone), clustered ring ( this is a BUZZWORD for DCIS or IDC)

RETICULAR and DENDRITIC have been removed

Question 10

What’s a buzzword for DCIS or IDC

Answer 10

clustered ring (like a diamond ring IDC=I Do Consent)

Question 11

Which words are no longer used in MRI lexicon

Answer 11

1. Shape: LOBULATED
2. Margin: SMOOTH
3. Internal enhancement pattern: ENHANCING INTERNAL SEPTATIONS and CENTRAL ENHANCEMENT
4. NME internal enhancement: RETICULAR and DENDRITIC