0:01

So, uh, I want to show you a case of

0:03

this protocol, and it's actually the

0:05

same patient that we just looked at, but

0:07

we'll be, um, scrolling through, uh, the

0:10

images, and, uh, this is a 43-year-old

0:12

woman who was seen for high-risk screening.

0:16

So, this is a case just to show

0:17

you what our protocol looks like.

0:20

This first view is the three-plane localizer.

0:25

So, here's our coronal

0:26

sequence, and then sagittal

0:32

through each breast, and then axial

0:40

coronal again.

0:40

All right, coronal, sagittal, and axial.

0:44

And really this is just so that the

0:47

technologists can check their positioning

0:49

and then prescribe the slices.

0:52

And.

0:53

Even though we'd like to ignore these

0:55

images, we are still responsible for them.

0:58

So, I do look at those first, just to make

1:00

sure that there isn't some problem outside

1:03

of the breast that should be reported.

1:09

This is our T1 sequence.

1:12

And just starting from the top,

1:18

it's going to move this up a little bit.

1:23

You can see the pectoralis major muscle

1:26

here and minor behind it, and a little bit

1:32

Level one lymph nodes coming into view here,

1:39

more lymph nodes.

1:41

And then as we move down, we're

1:42

getting into breast tissue.

1:46

Those cysts that we looked

1:47

at before, here are the cysts.

1:54

This is at the nipple level.

1:55

So, nipples are relatively symmetrically

1:58

positioned in this patient.

2:06

Kind of coming all the way through

2:07

to the bottom of the breast.

2:08

So, we do want to include from the

2:10

top to the bottom of the breast.

2:14

Let's see that that's all included here.

2:16

We have a good field of view.

2:18

We're seeing our lymph nodes

2:21

and muscular structures.

2:23

Then the next sequence is our STIR.

2:27

And again, taking that from the top, we

2:29

can see that our lymph nodes are

2:32

bright on STIR, as our blood vessels

2:37

and fatty tissue and muscular

2:39

tissue are going to be darker.

2:43

All of our cysts are going to be bright.

2:48

But not everything that's bright

2:49

on STIR is a cyst, because other

2:52

masses can be bright also.

2:55

You can see plenty of cysts in this patient.

3:01

Then we come over to our

3:05

T1

3:08

weighted sequence with fat saturation.

3:11

And sometimes fat saturation can

3:13

be a real challenge in MR,

3:16

especially at higher field strength.

3:18

But you can see in this case

3:19

that fat is reasonably uniformly

3:22

saturated and dark in color.

3:30

And in this, this patient has a little

3:33

bit of that T1 hyperintense signal

3:37

within subareolar or retroareolar ducts.

3:41

You can see them here and here.

3:43

And as I scroll through, you can see that

3:46

they are linear and branching structures,

3:51

in this case going almost all the way to

3:53

the back of the breast tissue, but those

3:55

are ducts containing proteinaceous fluid.

4:02

Then we give contrast.

4:06

This is our first post-contrast sequence.

4:09

We can see that our lymph nodes are now

4:12

enhancing, our blood vessels are enhancing,

4:17

and our breast tissue starts to enhance.

4:19

So, we can see lots of little dots

4:21

here within the tissue and

4:25

the breast tissue is enhancing.

4:27

We also get a nice look at our internal

4:31

mammary artery and vein here on both sides.

4:35

And that's where we would be looking for

4:39

lymphadenopathy.

4:44

And then our post-contrast sequence.

4:48

Basically, everything that's

4:50

showing up is enhancing, a lot of

4:53

background enhancement in this patient.

4:57

Lots of little foci scattered throughout.

5:01

Okay.

5:02

And then there'd be two

5:03

more sequences like that.

5:04

And then, then the myth, and

5:09

sometimes we can get this to tumble.

5:13

Here's the tumbling myth.

5:15

So, you can just move this around, we'll

5:19

usually also have one that rotates from right

5:22

to left, but this one tumbles and sometimes

5:25

that helps you in terms of looking at whether

5:28

something is a vessel versus linear non-

5:32

mass enhancement, but that's the tumbling.