0:01

So, our next case is a 56 year old woman for high risk screening.

0:05

She has a history of atypical ductal hyperplasia

0:08

and lobular carcinoma in situ in the past,

0:12

and multiple bilateral biopsies.

0:14

She also has a strong family history of breast cancer.

0:18

So this is the patient's MIP, you can see that she has

0:21

mild background parenchymal enhancement.

0:23

She has a couple of areas that really stand out

0:26

and enhancing mass here on the right side.

0:29

A few foci here on the right.

0:32

And then on the left, she has some foci and another little patchy

0:36

area of maybe focal non mass enhancement.

0:39

We'll investigate that further.

0:42

Just going to go ahead and grab her T1,

0:46

non-fat saturated and her

0:51

post contrast, first post contrast sub.

0:54

So we can see on the T1-weighted image is

0:57

that she has heterogeneous

1:00

hyperglandular tissue.

1:01

Her background parenchymal enhancement is relatively mild.

1:06

She does have some T1 hyperintense material in her

1:10

ducts, and that's related to proteinaceous fluid.

1:17

And we're seeing that on the left side, really.

1:19

I think she might have a little bit on the right,

1:21

but it's not as obvious.

1:24

We can also see

1:28

Biopsy clips.

1:34

Here's a particularly large susceptibility

1:36

artifact, but that's from a biopsy clip.

1:46

So then, just looking at these areas a little bit more closely,

1:50

she has this enhancing mass

1:57

in the right lateral breast, that was about 10 mm in size.

2:01

And we've been seeing this patient for a long

2:03

time, both with mammograms and MRI.

2:08

And so, we had at least 10 years worth of MRI studies

2:13

for her and that mass had been stable on all of them.

2:17

So this may be a little fibroadenoma but it

2:21

enhances pretty brightly, but it is stable.

2:24

So we consider this to be benign.

2:26

And of course, you wouldn't know that without prior

2:30

studies. If we didn't have prior studies,

2:32

we would investigate this probably with ultrasound

2:35

based on its size, and see if that was something

2:38

we could follow by ultrasound.

2:40

If not, we might biopsy it, either by ultrasound or MRI.

2:46

The other finding of note is this sort of focal

2:51

non mass enhancement. I'll show it to you on

2:59

the source images as well, so you can see no enhancement here.

3:03

And then you get this little focal area of enhancement.

3:07

And there were some other foci.

3:09

And once again, we were able to backtrack through numerous

3:17

prior exams and we found that that little patch of enhancement

3:22

had been stable for several years,

3:26

you know, more than 10 years.

3:28

So we determined that that was benign.

3:32

And we gave this exam a BI-RADS 2.