nzimrt conference 2014. the basicsthe basics equipment required clinical indications patient...

NZIMRT Conference 2014

MRI BREAST

The Basics

Equipment required Clinical Indications Patient PreparationSequences Image Appearances

And Beyond….

High Field Strength MRISpectroscopy

CONTENTS

The Basics

Equipment required Clinical Indications Patient PreparationSequencesImage Appearances

CONTENTS

Equipment

GE Signa HDx 1.5T scanner Dedicated 8ch Breast CoilPower Injector10mls MultihanceCADstream postprocessing

The Basics

Equipment required Clinical Indications Patient PreparationSequencesImage Appearances

CONTENTS

Screening for strong family historyExtent of known lesionEvaluate for disease in opposite breastScreening with BRCA 1 and BRCA 2

Clinical Indications

The Basics

Equipment required Clinical Indications Patient PreparationSequencesImage Appearances

CONTENTS

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

Patient Preparation

BREAST COIL SETUP

MRI Breast Exams

The Basics

Equipment required Clinical Indications Patient PreparationSequencesImage Appearances

CONTENTS

3 plane localizerCalibration scan AXIAL STIR

Gadolinium given

VIBRANT 32CMSAG T2 FAT SAT – Right SAG T2 FAT SAT – LeftAXIAL DWI b 750

Sequences

The Basics

Equipment required Clinical Indications Patient PreparationSequencesImage Appearances

CONTENTS

Normal Appearance

AXIAL STIR

VIBRANT PH 2

SAG T2 FAT SAT

TYPE I

Progressive enhancement pattern

TYPE II

Plateau pattern

TYPE III

Washout pattern

Washout curves

II

III

I

SIGNALINTENSITY

TIME

Early post contrast phase

Intermediate and late Contrast phase

65yr oldInvasive lobular cancer of the right breastPre-operative MRI

CASE 1

CASE 1

Case 1

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

Case 2

Case 2

Case 2

DWI ADC

Case 2

SINGLE VOXELSPECTROSCOPY

CHOLINE PEAK3.28ppm

52yr oldNipple inversion L breast when raising armsPalpable lump next to the left areola

CASE 3

Case 3

High Field Strength MRIBreast Spectroscopy

And Beyond…..

7TProvide higher SNRHigher spatial resolutionImproved detection of small lesionsHowever…. Lack of widespread availability No large clinical trials to show clinical advantage

High Field MRI

Demonstrates the chemical components or metabolites of selected tissue

Single voxel 20mm5min scanFor detection of choline peak

Spectroscopy

MRI breast scans have steadily increased in number

Commonly used as a screening tool for BRCA positive patients

Able to scan both breasts simultaneouslyContrast has changed from 20mls Magnevist

to 10mls of MultihanceDiffusion weighted imaging is now routine

part of examination

In Summary