0:00

So, this example is, I think, really remarkable.

0:04

This is a 51-year-old woman who also

0:07

had dense breasts mammographically.

0:09

A negative screener was a routine

0:11

screener and opted for supplemental

0:14

screening with abbreviated MR.

0:16

And what you can see is, again,

0:17

first a T1 up in the upper corner

0:20

here, really just to localize her.

0:22

Here's her T2.

0:24

And what you can see on her T2 is she's

0:26

got some prominent ducts bilaterally.

0:28

They're fluid-filled.

0:29

I think you can see those anteriorly here.

0:31

I'll blow it up for you,

0:33

you know, kind of symmetric.

0:36

You see some nodes; nothing really stands out.

0:40

Here's her pre-contrast down here.

0:41

I'm going to go directly to the post-contrast.

0:45

Non-sub and what you can see is a lot of regional

0:50

enhancement.

0:52

In the medial right breast, very

0:55

nodular, but a whole chunk of it.

0:57

Very, very impressive.

1:01

And now I want to show you her subtraction image.

1:04

And again, there's a little

1:06

bit of motion artifact.

1:07

You can see this extensive area, and

1:10

we're measuring it as about—it’s almost 12

1:13

centimeters right to the back of her nipple

1:17

along the medial aspect of that right breast.

1:20

So, incredibly extensive, asymmetric

1:23

enhancement; maybe there's even

1:25

some more centrally you can see.

1:27

So this is highly suspicious, and it makes you

1:29

say, well, what did her mammogram look like?

1:32

Let me show you that now.

1:35

So here's her mammogram, and down

1:36

below you can see her prior mammogram

1:39

and you can see how dense she is.

1:40

So you might say, you know, are there

1:42

calcifications in that linear area?

1:44

And here's the medial aspect of the right breast.

1:46

And you really don't see anything going on.

1:49

I'll show you now her MLO; you really don't see

1:52

anything remarkable that would correlate.

1:55

You know, there's maybe one calcification

1:56

there, but nothing that correlates

1:58

with what we're seeing on that MR.

2:01

Here's her tomo.

2:03

Which, again, you know, we saw some big

2:06

ducts and things, and I think you can see

2:08

those in our sub-area and maybe as we tomo

2:12

through in retrospect, you might say, you

2:14

know, there are some ducts and things like that,

2:16

but nothing that jumps out as remarkable.

2:19

And so,

2:21

really this cancer, this was extensive DCIS.

2:25

It was an intermediate-grade cribriform,

2:28

papillary, and micropapillary.

2:31

Because of the extent, she

2:32

went on to a node dissection.

2:33

You can see her nodes look

2:34

beautiful on that MLO mammogram.

2:36

And of course, they were negative.

2:38

But this is all about the dynamic

2:40

imaging that we can do with contrast.

2:43

And so, this was quite a remarkable case.

2:46

Unfortunately, she went on to mastectomy

2:48

because of the extent of the disease.

2:51

Again, she was extremely dense,

2:52

supplemental screening with abbreviated MR.