0:00

So the next case is a 72-year-old woman

0:05

who presented, uh, for dense breast

0:07

screening for one of our research protocols.

0:11

So you can see, uh, again, on, on top

0:14

there's a mediolateral oblique low energy

0:17

images; on the bottom, craniocaudal images.

0:20

You can set it up again however

0:22

you want on your, uh, PACS.

0:25

What is important about this case

0:27

is one of the pitfalls of which you, uh, would have

0:31

to get used to when you are, uh, just starting

0:34

your program, is axillary enhancement artifact.

0:38

So take a look.

0:39

So we, we saw that it was a heterogeneous

0:42

dense breast, probably mild, uh,

0:46

background parenchymal enhancement.

0:48

It's still a relatively uniform gray, slightly kind

0:52

of speckled appearance, so I would call it mild.

0:56

You see the, uh, dense calcification

0:59

that we had on the right.

1:00

So it's bright white, but on the recombined

1:04

image, it actually appears as a black dot.

1:08

But what I wanted to point out is this

1:11

enhancement, so you can see it on some

1:15

manufacturer's equipment more than others.

1:18

And, uh, definitely have to look at it and evaluate

1:23

it because cancers can appear like that.

1:25

But in this particular case,

1:27

it's relatively symmetric.

1:29

And what is, uh, important— so when you are

1:35

evaluating your lower energy image, you don't

1:38

see any parenchymal tissue there at all.

1:41

Any glandular tissue.

1:44

And there is this, uh, triangular-looking

1:47

artifact with a bit of enhancement

1:49

along the edge of the pectoralis muscle.

1:53

We usually don't see that, but sometimes

1:56

recombination to, to some, uh, software, uh, issues,

1:59

it can create this artifact.

2:01

So along pectoralis muscle, you can see

2:03

this bright line and this triangle.

2:06

Just keep in mind that usually it's symmetric

2:09

and when you're looking at the low-energy

2:11

images, there's usually nothing there.

2:14

And if you are in doubt, then you can, uh,

2:17

do an ultrasound of— for evaluating. In our case,

2:20

we also had the benefit of, uh, digital breast

2:23

tomosynthesis under the same compression.

2:25

And, uh, just scrolling through the

2:28

DBT images, just nothing there at all.

2:32

So in this case, this artifact

2:34

was relatively easy to dismiss,

2:36

uh, on those grounds. Sometimes it's not as

2:38

easy, so you need to do additional images, and

2:41

especially at the beginning, you may even end up

2:43

doing some biopsies of that, but it happens.