Breast mri 10

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Breast mri 10

  1. 1. . . . . By Women ImagingWomen Imaging UnitUnit Kasr El Aini – Cairo UniversityKasr El Aini – Cairo University
  2. 2. . . . In certain situations, clinical examination, mammography and ultrasonography have some limitations; due to factors in the modality or breast parenchyma MR imaging has an important role in clinical practice; both in lesion characterization and tumor staging. (Khatri rt al, 2001( A major cost reduction can be achieved by prevention of unnecessary surgery, and additional trauma for the patient. )Schmitt et al, 2001(
  3. 3. . . . . . .. . Sensitive to small abnormalitiesSensitive to small abnormalities.. Effective in dense breastsEffective in dense breasts.. Characterization of breast lesionsCharacterization of breast lesions.. Staging of malignant neoplasmStaging of malignant neoplasm.. Follow-up of patients after different lines of treatmentFollow-up of patients after different lines of treatment Can image breast implant/ruptureCan image breast implant/rupture.. Can locate occult primary tumor in women whoCan locate occult primary tumor in women who present by malignant axillary lymph nodepresent by malignant axillary lymph node .
  4. 4. . . . Cannot image calcifications, as tiny calciumCannot image calcifications, as tiny calcium deposit can indicate early breast cancersdeposit can indicate early breast cancers.. Expensive and not widely availableExpensive and not widely available.. Some patients who are claustrophobic may notSome patients who are claustrophobic may not tolerate MRItolerate MRI.. Requires use of contrast agentRequires use of contrast agent.. More time-consuming than mammographyMore time-consuming than mammography.. . . .. . .
  5. 5. . . Suspicious mammographicSuspicious mammographic findings of malignancy includefindings of malignancy include:: Spiculated or stellate masses with or without micro-calcifications. Asymmetrical breast tissue especially when associated with calcifications. Areas of architectural distortion. Pleomorpheic micro-calcifications that are greater than five in number.
  6. 6. . Patterns of normal parenchymal enhancement 1 No enhancement 2 Minimal or mild enhancement 3 small focal areas of slow or rapid enhancement 4 slow or rapid regional enhancement 5 slow or rapid patchy enhancement 6 Diffuse slow enhancement . . . . .T2WI Fat suppressedT2WI Fat suppressed T1WIT1WI
  7. 7. . . . . . . Qualitative methodsQualitative methods Quantitative methodsQuantitative methodsQualitative methodsQualitative methods 11--Early appearance of enhancementEarly appearance of enhancement 22--Peripheral lesion enhancementPeripheral lesion enhancement 33--Border irregularityBorder irregularity 44--Enhancement inhomogeneityEnhancement inhomogeneity 55--converging vesselsconverging vessels 66--Signs of malignancy spreadSigns of malignancy spread
  8. 8. . . . . . . Quantitative methodsQuantitative methods 11--Enhancement amplitude in theEnhancement amplitude in the 1st two min1st two min.. 22--Early peak of enhancementEarly peak of enhancement curvecurve 33--Early washoutEarly washout . MalignantMalignant BenignBenign 22minmin.. 77minmin.. <<6060%%>>6060%%
  9. 9. ..
  10. 10. .. 3 minutes 110% Bilateral breast fibroadenoma s
  11. 11. .. 7 minutes 70 % Granulomatus mastitis
  12. 12. .. 7 minutes 25 % Benign phylloids tumor grade II
  13. 13. .. 4 minutes 70 % Invasive Duct Carcinoma grade II
  14. 14. .. 4 minutes 70 % Multifocal Invasive Duct Carcinoma grade II .
  15. 15. .. 3min.—105% 4min.– 70% 4min.– 70% Inflammtory Carcinomatosis + Invasive Duct Carcinoma
  16. 16. .. 3min.—105% 7min.– 90% 10min.– 90% Multicentric Invasive Lobular Carcinoma grade IV
  17. 17. .. 4 minutes 85 % Paget’s Disease of the Nipple
  18. 18. .. 3 minutes 35 % Mucinous Adeno - carcinoma
  19. 19. .. 7 minutes 82.5 % Adenoid Cystic Carcinoma
  20. 20. .. .
  21. 21. . Post contrast MRM can give relevant additional information in patients with mammographically dense breasts, or inhomogeneous tissue on sonography, or both. Both qualitative and quantitative criteria are needed for lesion interpretation. Preoperative post contrast breast MRI has the potential to reveal mammographically & sonographically hidden multifocal, multicenteric, or contralateral breast carcinoma
  22. 22. Additional diagnostic studies Breast US &/or DopplerBreast US &/or Doppler ResultsResults Normal Benign Indeterminate/Suspicious Possibly malignant 6-month follow-up Guided biopsy Surgical biopsy .Suspicious MammogramsSuspicious Mammograms Microfocal spot magnification Compression & oblique images Dynamic post-contrast MR mammography
  23. 23. . . .

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