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By

Women Women Imaging UnitImaging Unit

Kasr El Aini – Cairo Kasr El Aini – Cairo UniversityUniversity

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In certain situations, clinical examination, mammography and ultrasonography have some limitations; due to factors in the modality or breast parenchymaMR imaging has an important role in clinical practice; both in lesion characterization and tumor staging. (Khatri rt al, 2001)A major cost reduction can be achieved by prevention of unnecessary surgery, and additional trauma for the patient . (Schmitt et al, 2001)

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Sensitive to small abnormalitiesSensitive to small abnormalities..

Effective in dense breastsEffective in dense breasts..

Characterization of breast lesionsCharacterization of breast lesions..

Staging of malignant neoplasmStaging of malignant neoplasm..

Follow-up of patients after different lines of Follow-up of patients after different lines of treatmenttreatment

Can image breast implant/ruptureCan image breast implant/rupture..

Can locate occult primary tumor in women who Can locate occult primary tumor in women who present by malignant axillary lymph nodepresent by malignant axillary lymph node

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Cannot image calcifications, as tiny Cannot image calcifications, as tiny calcium deposit can indicate early calcium deposit can indicate early breast cancersbreast cancers..

Expensive and not widely availableExpensive and not widely available..

Some patients who are claustrophobic may not Some patients who are claustrophobic may not

tolerate MRItolerate MRI..

Requires use of contrast agentRequires use of contrast agent . .

More time-consuming than mammographyMore time-consuming than mammography . .

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Suspicious mammographic Suspicious mammographic findings of malignancy findings of malignancy

includeinclude::

Spiculated or stellate masses with or without micro-calcifications.

Asymmetrical breast tissue especially when associated with calcifications .

Areas of architectural distortion.

Pleomorpheic micro-calcifications that are greater than five in number.

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Patterns of normal parenchymal enhancement

1 No enhancement

2 Minimal or mild enhancement

3 small focal areas of slow or rapid enhancement

4 slow or rapid regional enhancement

5 slow or rapid patchy enhancement

6 Diffuse slow enhancement

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.T2WI Fat suppressedT2WI Fat suppressed T1WIT1WI

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Qualitative methodsQualitative methods Quantitative methodsQuantitative methods Qualitative methodsQualitative methods

11 - -Early appearance of Early appearance of enhancementenhancement

22 - -Peripheral lesion enhancementPeripheral lesion enhancement

33 - -Border irregularityBorder irregularity

44 - -Enhancement inhomogeneityEnhancement inhomogeneity

55 - -converging vesselsconverging vessels

66 - -Signs of malignancy spreadSigns of malignancy spread

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Quantitative methodsQuantitative methods

11--Enhancement amplitude in Enhancement amplitude in the 1st two minthe 1st two min..

22--Early peak of enhancement Early peak of enhancement curvecurve

33 - -Early washoutEarly washout

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MalignantMalignant

BenignBenign

22 minmin..

77 minmin..

> >

6060%

%

< <6060

%

%

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3 minutes

110%

Bilateral breast

fibroadenomas

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7 minutes

70 %

Granulomatus mastitis

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7 minutes

25 %

Benign phylloids

tumor grade II

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4 minutes

70 %

Invasive Duct

Carcinoma grade II

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4 minutes

70 %Multifocal Invasive

Duct Carcinoma grade II

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3min.—105%4min.– 70%4min.– 70%

Inflammtory Carcinomatosi

s +

Invasive Duct Carcinoma

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3min.—105%7min.– 90%10min.– 90%

Multicentric Invasive Lobular

Carcinoma grade IV

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4 minutes

85 %

Paget’s Disease

of the Nipple

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3 minutes

35 %

Mucinous Adeno -

carcinoma

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7 minutes

82.5 %

Adenoid Cystic

Carcinoma

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Post contrast MRM can give relevant additional information in patients with mammographically dense breasts, or inhomogeneous tissue on sonography, or both.

Both qualitative and quantitative criteria are needed for lesion interpretation.

Preoperative post contrast breast MRI has the potential to reveal mammographically & sonographically hidden multifocal, multicenteric, or contralateral breast carcinoma

Additional diagnostic studies

Breast US &/or DopplerBreast US &/or Doppler

ResultsResults

Normal Benign

Indeterminate/Suspicious

Possibly malignant

6-month follow-up Guided biopsy Surgical biopsy

.Suspicious Suspicious MammogramsMammograms

Microfocal spot magnification

Compression & oblique

images

Dynamic post-contrast MR mammography

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