Publication for the Philips MRI Community

FieldStrengthIssue 41 – September 2010

SPECIAL ISSUEMR in oncology

This article is part ofField Strength issue 41,September 2010

Vanderbilt runs dedicatedbreast MR scannerVanderbilt Breast Center sees advantages of MammoTrak with Achieva for conveniently providing comprehensive services to patients

Vanderbilt runs dedicated breast MR scanner Vanderbilt Breast Center sees advantages of MammoTrak with Achieva for conveniently providing comprehensive services to patients

The Vanderbilt Breast Center (Nashville, Tennessee, USA) was established in 1991 in response to a growing need for comprehensive, multidisciplinary breast services. The breast center moved to a new, expanded location in Spring 2009 and now provides clinical and imaging services under one roof, including MRI.

John G. Huff, MD is Associate Professor of Radiology and Imaging Director at Vanderbilt Breast Center. “The dedicated MR scanner in the breast center enables us to provide a higher level of personal service to our patients, with greater scheduling flexibility,” he says. “It allows us to serve out-of-town patients in one location, and we are able to have technologists specialized in breast imaging.”

Oncology is primary indicationDr. Huff says the Center scans up to 60 patients a month with Achieva 1.5T XR, from referrals including its own clinical services, Vanderbilt primary care providers, and other centers in the area. “Our two MRI technologists perform everything from helping the patient undress and starting IV’s to scanning and discharging, in 1:30-hour time slots.”

The Center’s main indication for breast MR, about 60 percent, is for patients with a new diagnosis of breast cancer, defining the extent of ipsilateral disease and assessing for contralateral disease. About 15 percent of the volume comes from imaging women who are referred because of their high risk for breast cancer. “We also assess implant integrity and determine response to neoadjuvant therapy,” Dr. Huff notes. “Other indications include positive surgical margins when pre-operative MRI was not performed, scar versus recurrence in patients who have undergone breast conservation, and interval follow-ups of probably benign MRI findings.”

MammoTrak benefits patients and performance“The MammoTrak dockable patient support system with its integrated 7-channel and 16-channel coils is a great improvement over previous configurations,” says Dr. Huff. “Putting patients into

John Huff, MD, served as Chief of Breast Imaging

at Baptist Hospital (Nashville, Tennessee,

USA) and Imaging Director of the Baptist

Comprehensive Breast Care Center from 1992

until July 2007, when he joined the Vanderbilt

Breast Clinic. Dr. Huff has a special interest

in breast MRI and oversaw the development

of Specialty MRI, Middle Tennessee’s first

dedicated breast MRI facility where he served

as Medical Director from 2005 to 2007.

“Putting patients into the magnet feet first is a plus. It allows us to scan patients who would simply not have fit in the bore head first.”

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FieldStrength – Issue 41 – September 201018

Known left breast malignancy

57-year-old female with recent histologic diagnosis of malignancy in upper outer quadrant of posterior left breast. She presented for an MRI study for determination of extent of disease on the ipsilateral side and possible contralateral involvement. There is heterogeneously dense breast tissue and a strong family history including a brother with a diagnosis of breast cancer. The recently biopsied malignancy in the left breast is well demonstrated, with adjacent marking clip. A small focus in the retroareolar right breast is noted, follow up is recommended.

T2 SPAIR T1W TSE

T1W FFE e-THRIVE

T2 SPAIR T1W TSE

T1W FFE e-THRIVE

Right breast mass

36-year-old female with new diagnosis of breast cancer and extremely dense breast tissue presents for evaluation of the extent of disease and evaluation of the contralateral breast. She has not had radiation or chemotherapy yet. A large lobulated mass is seen in the superior lateral right breast corresponding to the known malignancy. No obvious chest wall involvement is seen. Enlarged and morphologically suspicious right axillary lymph nodes are seen. No abnormalities seen in the left breast.

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T2 SPAIR T1W TSE

T1W FFE e-THRIVE

Patient with reconstructed breast an implants

56-year-old female with bilateral chest wall pain, left greater than right, and intermittent pressure occasionally associated with sensation of left axillary fullness. The patient has a history of extensive multifocal left breast ductal carcinoma in situ. The patient is status post bilateral partial mastectomies 4 years ago with breast reconstruction including tissue expanders and bilateral silicone implants. No suspicious lesions are seen on either side. The silicone implants are well visible in the reconstructed breasts. BI-RADS Category 2.

the magnet feet first is a plus. It allows us to scan patients who would simply not have fit in the bore head first. Image quality is excellent and the dockable MammoTrak enables a smooth workflow for biopsy procedures. This Philips solution is really great.”

The Center performs one or two breast biopsies a week using the 7-channel coil, which allows biopsy access from a superior or cranial approach in addition to medial and lateral. For diagnostic imaging, the 16-channel coil provides enhanced spatial and temporal resolution for improved visualization of small lesions.

Overall, having a dedicated MR system in the breast center is a huge advantage, says Dr. Huff. “It’s convenient for the patients, and much more private than a hospital MR setting. It facilitates interdisciplinary decision-making and keeps the patient at the center of the management team.”

“We’re scanning at 1.5T right now because that’s where most of our experience is, and the majority of our clinical needs are met,” explains Dr. Huff. “But we might consider upgrading to 3.0T in the future.”

“The dedicated MR scanner in the breast center enables us to provide a higher level of personal service to our patients, with greater scheduling flexibility.”