0:01

Our next case is a 45-year-old

0:03

woman for high-risk screening.

0:06

So this is our MRI on our patient.

0:09

We can see that there's a lot of background

0:11

parenchymal enhancement bilaterally.

0:13

We see her normal blood vessels, and there

0:15

are a few enhancing foci of enhancement.

0:18

We'll go back out and get her T1-weighted nonfat

0:21

10 00:00:26,000 --> 00:00:28,919 saturated images on the left and her first

0:28

post-contrast subtracted images on the right.

0:32

And this patient has had some

0:34

biopsies so you can see susceptibility

0:37

artifact from biopsy clips,

0:41

and there was one biopsy on each side.

0:43

So susceptibility artifacts here on

0:46

the right upper central and then left

0:50

anterior central breast, and those were

0:53

from prior benign MRI-guided biopsies.

0:58

And then on her subtracted images, there's a lot

1:03

of background enhancement, marked background.

1:06

It's asymmetrically more on the right side,

1:09

kind of more in the periphery of the breast.

1:14

Luckily, we had prior images to compare, and

1:19

all of the areas of enhancement were stable.

1:22

So she does definitely have some

1:24

focal non-mass enhancement and some

1:27

enhancing foci, but they were stable.

1:31

And when we first saw this patient, background

1:35

enhancement worried us quite a bit, and we

1:39

ended up doing bilateral MRI-guided biopsies

1:43

for areas that turned out to be benign.

1:46

And then we've just been following

1:48

them over time since then.

1:51

So just an example of marked

1:52

background enhancement.

1:56

But a BI-RADS 2 exam, and of course, we would

1:59

look at all series and her color images and

2:04

everything else, but, and then of course I

2:08

think in this kind of case comparison to

2:10

prior is going to be the most helpful part.

2:12

This is her T1 pre-contrast and post-contrast

2:17

the source images, which can be very helpful.

2:20

But basically, this patient

2:23

might be concerning if you were seeing her

2:27

on her baseline exam, but because everything

2:29

was stable, this was considered a BI-RADS 2.