0:01

Our next patient is a 42 year old woman with

0:04

a recent diagnosis of left breast cancer,

0:07

and MRI is being performed to assess extent of disease.

0:12

So here's the patient's MIP,

0:15

and you can see that there's a large enhancing mass here,

0:18

posteriorly in the left breast and some lymph nodes, bilaterally.

0:23

She has a lot of little foci in both breasts,

0:26

likely related to background parenchymal enhancement.

0:30

We'll take a look at our T1 and our subtraction series.

0:38

And we can see that she has heterogeneous background

0:43

parenchymal enhancement, or background tissue.

0:47

And then she has a moderate background

0:49

parenchymal enhancement.

0:53

But a lot of this is just scattered foci,

0:57

nothing really suspicious.

1:00

Then we get into this enhancing mass.

1:05

There's artifact from a biopsy clip internally.

1:12

And surprisingly,

1:15

you know,

1:15

sometimes with a mass, this size will see

1:18

abnormal lymph nodes,

1:19

but her lymph nodes are normal in appearance,

1:23

bilaterally.

1:27

One thing that we always want to be aware of

1:29

when we're looking at a breast cancer that's more medial,

1:35

which this is,

1:36

we want to be sure to check our internal

1:38

mammary lymph nodes, which we did.

1:42

And here they are, internal mammary artery and veins.

1:46

We're going to follow those, and basically no

1:53

visible lymph nodes.

1:55

So really just the one cancer and some background.

1:59

We can see this on T1-weighted series pre and post contrast.

2:08

Nothing else that we can see there.

2:11

And you can see based on how I'm

2:13

reviewing these studies, that although we have

2:18

all these series, we may not use them very much other than for

2:27

kinetics or trying to figure something out.

2:31

Our pre and post contrast series with our sub

2:34

and our MIP are going to be the most important things

2:39

that we look at with some contribution by the T1

2:42

non-fat saturated and STIR sequences.

2:46

And if you think about it,

2:47

most abbreviated protocols at this point are

2:52

T1-weighted pre and post contrast

2:55

and maybe

2:56

maybe a STIR or some sort of

2:58

T2-weighted sequences added as well.

3:02

But that, that forms the bulk of what we look at.

3:06

And then the second and third and subsequent sequences

3:10

after contrast are mostly to get information about kinetics.

3:16

But I'm showing you the second and third sequence here,

3:20

I don't think it contributes a whole lot to our

3:23

overall understanding of this patient.

3:28

Okay, so this was a BI-RADS 6.

3:29

She only had the index mass and nothing

3:32

else that we were worried about.