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