NZIMRT Conference 2014

The BasicsThe Basics  Equipment required  Clinical Indications  Patient Preparation  Sequences  Image Appearances

GE Signa HDx 1.5T scanner Dedicated 8ch Breast Coil Power Injector 10mls Multihance CADstream postprocessing

The BasicsThe Basics  Equipment required  Clinical Indications  Patient Preparation  Sequences  Image Appearances

Screening for strong family history Extent of known lesion Evaluate for disease in opposite breast Screening with BRCA 1 and BRCA 2

The BasicsThe Basics  Equipment required  Clinical Indications  Patient Preparation  Sequences  Image Appearances

 45mins allocated exam time  Patient completes paperwork Screening and consent form Contrast assessment form Breast questionnaire  20g IV line inserted  Patient positioned feet first prone  Breast in centre of the coil, hanging freely.  Check there is no breast folds or tissue caught between chest wall and coil  Arms above head resting on arm supports

The BasicsThe Basics  Equipment required  Clinical Indications  Patient Preparation  Sequences  Image Appearances

 3 plane localizer  Calibration scan  AXIAL STIR  Gadolinium given  VIBRANT 32CM  SAG T2 FAT SAT – Right  SAG T2 FAT SAT – Left  AXIAL DWI b 750

The BasicsThe Basics  Equipment required  Clinical Indications  Patient Preparation  Sequences  Image Appearances

AXIAL STIR VIBRANT PH 2 SAG T2 FAT SAT

 TYPE I Progressive enhancement pattern  TYPE II Plateau pattern  TYPE III Washout pattern II III I SIGNAL INTENSITY TIME Early post contrast phase Intermediate and late Contrast phase

65yr old Invasive lobular cancer of the right breast Pre-operative MRI

79yr old Gross lymphadenopathy in the right axilla ? Primary or secondary disease

DWIADC

Case 2 SINGLE VOXEL SPECTROSCOPY CHOLINE PEAK 3.28ppm

52yr old Nipple inversion L breast when raising arms Palpable lump next to the left areola

High Field Strength MRI Breast Spectroscopy

7T Provide higher SNR Higher spatial resolution Improved detection of small lesions However…. Lack of widespread availability No large clinical trials to show clinical advantage

Demonstrates the chemical components or metabolites of selected tissue Single voxel 20mm 5min scan For detection of choline peak

MRI breast scans have steadily increased in number Commonly used as a screening tool for BRCA positive patients Able to scan both breasts simultaneously Contrast has changed from 20mls Magnevist to 10mls of Multihance Diffusion weighted imaging is now routine part of examination