Women ImagingWomen Imaging
Kasr El Aini – Cairo UniversityKasr El Aini – Cairo University
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(
. . .. .
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
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..
. . .. .
Suspicious mammographicSuspicious mammographic
findings of malignancy includefindings of malignancy include::
Spiculated or stellate masses with or without
Asymmetrical breast tissue especially when
associated with calcifications.
Areas of architectural distortion.
Pleomorpheic micro-calcifications that are
greater than five in number.
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
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
Preoperative post contrast breast MRI has the potential to
reveal mammographically & sonographically hidden
multifocal, multicenteric, or contralateral breast carcinoma
Additional diagnostic studies
Breast US &/or DopplerBreast US &/or Doppler
Normal Benign Indeterminate/Suspicious
6-month follow-up Guided biopsy Surgical biopsy
.Suspicious MammogramsSuspicious Mammograms
Dynamic post-contrast MR