Breast imaging

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  • The mammogram is an x-ray image of the breast. The normal breast architecture, seen on a mammogram, shows an oriented texture pattern made of lines converging to the nipple. This is due to the network of ducts and ligaments that are part of the breast. The presence of cancer modifies this regular appearance.
    Some of the abnormalities that can be observed in a mammogram are:
    masses, which are brighter than the normal tissue,
    calcifications, appearing as little bright spots,
    the asymmetry between breasts, which is also a suspicious sign,
    and architectural distortion, where the normal architecture of the breast is distorted, with no mass visible.
    Architectural distortion is quite often missed in screening
  • Breast imaging

    1. 1. Breast imaging •Mammography . •US & colour Doppler . •Galactography . •MRI (dynamic contrast enhanced). •CT. •Scintigraphy .
    2. 2. How do we perform mammography? MAMMOGRAPHIC TECHNIQUE
    3. 3. Mammogram Procedure • The breast is first placed on a platform and squeezed between 2 plates • Breast compression is necessary to: 1)even out the breast thickness so all tissue can be visualized 2) spread out tissue so small abnormalities won't be obscured by overlying breast tissue 3)allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged 4)hold the breast still to eliminate blurring of image caused by motion 5) reduce x-ray scatter to increase sharpness of picture.
    4. 4. MEDIOLATERAL OBLIQUECRANIOCAUDAL
    5. 5. MIRROR IMAGE COMPARE SIMILAR AREAS
    6. 6. Mammography
    7. 7. Benign breast lesions
    8. 8. Malignant breast lesions • Masses/ tumors • Calcifications • Asymmetry • Architectural distortion Signs of Breast Cancer:
    9. 9. Examples of benign and malignant calcifications
    10. 10. • Ductography of the breast is an underused procedure that often helps define the cause of unilateral, single-pore, spontaneous nipple discharge. • Nipple discharge may be caused by benign tumors, such as papillomas, or by carcinoma,
    11. 11. Ductography A B C D
    12. 12. • The term proximal ducts refers to ducts within the breast tissue or in the central breast, where the terminal ducts lead to lobules (acini). The term distal ducts refers to ducts "downstream" (or toward the nipple) from the proximal ducts. Therefore, the "distal-most ducts" are directly beneath the nipple
    13. 13. Advantages of US • Availability :  Widely available technology .  Mobile equipment .  Cost effective technique.  No film developing  No radiation exposure
    14. 14. • Good sound penetration in dense glandular tissue :  young women ( up to 30 years).  Benign breast diseases .  Post menopausal women on hormone replacement therapy .
    15. 15. • Differentiation of cystic and solid masses . • Good soft tissue discrimination . • Detect multifocal lesions. • Precise measurement of tumour extent . • Accurate guidance of interventional procedures .  Needle localization.  Tissue sampling: FNA & core biopsy
    16. 16. Skin Subcut.fat Retromamm. fat Pectoralis Rib
    17. 17. Fibroadenosis
    18. 18. • MRI is highly sensitive in detecting breast cancer, but high cost and low specificity have continued to limit the use of MRI as a screening tool. Another problem is that MRI cannot identify malignant calcifications • Potential roles for contrast-enhanced MRI of the breast:  (1) determining the size and extent of known invasive cancers.  (2) identifying multi-centric lesions.  (3) evaluating the ipsilateral breast of a woman who comes initially to attention with axillary metastases.  (4) identifying a recurrent carcinoma in a conservatively treated breast. .
    19. 19. ImagIng In gynecology
    20. 20. Imaging modalities I.Plain film : Soft ovoid density separated by fat planes Abnormality:  Soft tissue tumefaction : distended bladder , ovarian cyst, fibroid uterus .  Obliteration of normal fat planes>>infection.  Calcifications: fibroid, ovarian(dermoid).  Missed IUD.  Ascites ,hemo/pnemo- peritonium.
    21. 21. Imaging modalities  HSG .  Vaginography .  GIT studies .  IVU .  Arteriography (AVM , fibroid embolization).  Venography: iliac vein thrombosis. •II. Contrast Studies :
    22. 22.  Infertility : tubal obstruction , congenital uterine anomalies .  After tubal surgery: patency and configuration of F.T.  Recurrent abortion : width and configuration of internal os , cervical canal , congenital anomalies , fibroids.  Abnormal uterine bleeding : fibroids , endometrial polyps, adenomyosis, uterine adhesions .  Post caesarian section : assess integrity of uterine scar.  Intervention : tubal recanalization . HSG •Indications:
    23. 23.  Timing.  Empty bladder.  Position.  Instrument : metal canula , vaccum uterine canula , 8f foley catheter .  Contrast : •Technique: •Water soluble: urographin / non ionic. •Lipidol .
    24. 24.  Pregnancy.  Pelvic infection  Immediate pre and post mentrual phases. (Extravasation).  Sensitivity to contrast media. Contraindications :
    25. 25. Ext.os Cervical canal Int.os Uterine cavity Myom. Int.segment isthmus ampulla Fimbriaovary
    26. 26. Normal HSG • The Fallopian tubes are paired structures of 10- 20cm in length. • Three segments, the interstitial portion, the isthmus, and the ampulla . • Cornual sphincter: pear shaped separated from the uterine body by a short dark line due to mucosal fold .
    27. 27. Uterine anomalies
    28. 28. Intrauterine filling defect Fibroid
    29. 29. Bilateral hydrosalpinx
    30. 30. gynecologIc US I. Scanning technique: • Uses transducers 3-5MHZ range. • Requires filling of the urinary bladder (ideal 1-2 cm above the uterine fundus). • Obtained in sagittal and transverse planes (oblique image may be needed) • To view adnexa move transducer from side to side. • Main advantage providing an overview of the pelvis. A-TAS
    31. 31. • Performed with 5-9 MHZ transducers . • Empty bladder: To minimize discomfort Brings uterus and ovaries into focal zone. • Probe should be disinfected , Use gel applied to transducer head ,use condom . • AP& transverse pelvic planes. B-TVS
    32. 32. 1. Early and second trimester pregnancy. 2. Lower uterine segment in late pregnancy. 3. Ectopic pregnancy. 4. Retroverted or retroflexed uterus. 5. Obese and gaseous patients. 6. Emergency cases where bladder is empty. 7. Follicular monitoring in ovulation induction. 8. Pulsed and colour Doppler. Indications of TVS
    33. 33. Sonographic anatomy 1. Size . 2. Position . 3. Endometrial lining . 4. Myometrium The uterus
    34. 34. Uterus • Varies with age and parity . • Average: o Length= 6-8 cm . o Ap = 3-4 cm . o Transverse= 5cm Size
    35. 35. Endometrium :
    36. 36. Myometrium • Fibroids are very common. They occur in 2 or 3 out of every 10 women over age 35. • It is common to have more than one fibroid. Some women may have as many as a hundred. • Fibroids occur most often in women between ages 30 and 50, although women in their 20s sometimes have them. • Three out of every 10 hysterectomies in the United States are performed because of fibroids.
    37. 37. • Identified by:  Internal iliac artery  Elliptic shape  Multiple small cysts representing follicles. • Size: 4x3x2 cm ,mean volume=10cc. • Dominant follicle : (2-2.5 cm) The ovaries
    38. 38. • CT: • Assessment and staging of neoplasms of pelvic organs. • MRI: • T2: to assess normal uterine and ovarian anatomy , associated pathological conditions . • T1: better lesion characterization ,presence or absence of LN.
    39. 39. Normal MRI

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