What are the indications for Breast MRI?
Evaluation of extent of disease
Axillary lymphadenopathy with unknown primary
One time screen of contralateral breast with newly diagnosed breast cancer
Evaluate treatment response to neoadjuvant population
High risk screening
What are the high risk indicators for Breast MRI screening?
Very strong family Hx of breast cancer
Prior chest radiation therapy < 30 years (lymphoma)
Histologic dx of LCIS/atypia
Personal history of breast cancer
Very dense breast at mammography
When is screening MRI recommended?
>20% lifetime risk of breast cancer
What can cause erronious enhancement on Breast MRI?
Hormonal fluctuations in premenopausal women
- worst during 2nd half of menstrual cycle
- best time to scan between days 3-14
How do you perform Breast MRI guided procedures?
1) Prone position
2) "Open configuration" breast coil
3) Use grid compression device to aid localization
4) MR compatible biopsy device
5) Place fiducial markers
6) Mark mass on image
7) Count # of slices from site of entry to mass (Depth to place needle = # of slices x slice thickness)
8) Insert trochar and replace with plastic obdurator and rescan
9) Obtain biopsies
10) Leave clip and rescan to confirm clip placement
What is bad with water saturation?
Cannot see enhancing masses
Does Breast MRI for implants include contrast?
No, can miss cancer
What causes linguine sign?
Silastic elastomr shell contains silicone
When shell breaks, cause the shell to collapse
What causes a large area of breast susceptibility artifact in a patient with a reported implant?
Breast tissue expander