PEPconnect

Breast MRI: General Imaging

In the evaluation of breast cancer, Breast MR has become an important problem solving tool as an adjunct to mammography and ultrasound.

By the end of this course the user will be able to:

Define Clinical indications of breast imaging.
Identify Coils utilized for breast imaging
Perform Patient Preparation & breast Imaging
Identify Sequences for Breast Imaging
Demonstrate Post Processing Data

 

By the end of this course you will be able to:   Define clinical indications Identify coils Perform patient preparation & breast imaging Identify sequences for breast imaging Demonstrate post processing data Mammography Ultrasound MRI Screening (> 50y) Risk-groups In case of suspect findings Further clarification of suspect findings Young women High-risk groups Ruptured implants Scar or recurrence Cancer of unknown primary        +  microcalcifications        –  dense breasts        –  radiation dose          +  no radiation        +  dense breasts        –  high inter-observer variability          +  dense breasts        +  no radiation        +  no compression        –  costs Clinical Indications Women at great risk for cancer   BRCA gene carriers   Lifetime risk of breast cancer of about 20% to 25% according to risk assessment tools   Had radiation therapy to the chest   Other genetic diseases   Li-Fraumeni syndrome Cowden syndrome Bannayan-Riley-Ruvalcaba syndrome   Lifetime risk of breast cancer   According to risk assessment tools based mainly on family history   Personal history of breast cancer   Ductal carcinoma in situ (DCIS)   Lobular carcinoma in situ (LCIS)   Abnormal breast cell changes   Atypical ductal hyperplasia (ADH)   Atypical lobular hyperplasia (ALH)   Dense or unevenly dense breast tissue Accuracy of tumor size increases   Classification and nodal staging, multi-focal Silicone Saline MR is not affected by the implant (saline or silicone) Reliable study for rupture and freely injected silicone Mammography Ultrasound MRI Breast Coils and Patient Preparation     • Breast MRI should be performed with a dedicated breast MRI Coil   • Breast coil should have higher SNR, good homogeneity, and signal penetration   Breast 18 16-ch AI Breast Coil 2/10/16-ch Sentinelle Breast Coil 2/4/8-ch Sentinelle Breast Coil         Breast Matrix Coil EZ: 4-ch Sentinelle Breast 4-ch BI Breast Coil EZ: 4-ch Sentinelle Breast Coil, biopsy setup Information to include on screening form:   History of Surgery Hormone Therapy Menstrual Cycle Explain procedure before positioning patient on table   During the breast exam, the patient is prone with arms above the head or down at the side   Compression to touch   Patient can be positioned head or feet first depending upon your MR system and coil plug configuration   Communication very limited during exam Position breasts symmetrically Nipples straight down in 12:00 o’clock position No Skin Folds Check positioning on 3 plane localizer Skin folds Uneven fat saturations results May mask pathology Fat Saturation Techniques and Sequences Fat protons saturated by frequency-selective RF pulses   Magnet homogeneity affects fat sat   Contrast parameter card   Fat saturation – select fat sat under ‘Fat suppression’ Signal dependent relaxation time of tissue   TI for Fat suppression   180° – 90° – 180° RF pulse scheme   Inverts longitudinal magnetization in the opposite direction   Two or more RF pulses used to excite water protons only   First RF pulse excites both fat and water    Due to difference in resonant frequencies, de-phasing begins   Another RF pulse sent to hit fat   Only water displayed Spectrally selective fat saturation pulse is used to automatically calculate inversion time to minimize fat signal Alternative fat suppression technique   Only fat spins are affected. No STIR like contrast   Insensitive to B1 inhomogeneity   Local variations of actual flip angle Fat peak 220 Hz from water at 1.5T   440 Hz from water at 3T System Card > Adjustments Tab > Select > Confirm Frequency Adjustment   White tick mark   Displays center frequency peak selected   Frequency (temp) [Hz]   Temporary center frequency numerically displayed, can be modified   Frequency (sys) [Hz] indicates   System center frequency numerically, can NOT be modified Right Mouse Click within spectral display   Select – Zoom x 5   Easier viewing of small peaks Center cursor on Fat Peak   Left mouse click on Fat Peak   After clicking on Fat Peak, new frequency (temp) graphically indicated by line   By numerical value   Frequency (temp) graphically   Frequency (temp) numerical   Add 220 Hz (1.5T) or 440 Hz (3T) to Frequency (temp)   New Frequency (temp) delivers fat saturation pulse directly over fat peak   Select Apply - Updates Frequency (temp)   Select Continue   Only one peak identified:   Automatically defined as fat peak    220 Hz  (1.5T) or 440 Hz (3T) added to system frequency   Two peaks identified:   System is tuned to water as well   Option optimizes measurements if patient has dominant fat tissue Two point Dixon technique   FL3D VIBE - integrated into sequence TSE VIBE Dixon Good fat suppression including axilla   In phase and water image Flash Fatsat Vibe Dixon Skyra - 1.0 x 0.85 x 1.5mm TA - 1 min Fat Water Fast T2 TSE Dixon Enables dual-echo Dixon   Less affected by motion   Reduction in scan time without significant loss in image quality Standard Dixon Scan time:  3:31 0.9 x 0.9 x 4mm Fast Dixon Scan time:  1:47 0.9 x 0.9 x 4 mm Transverse   Visualization of internal-mammary lymph nodes   Common correlation to mammography   Easier differentiation of vessel vs. enhancing ducts   Direct temporal comparison of both breast   Phase encoding should be right to left Fat saturated   3D   Utilizing the full potential of MRI   Bilateral   Both breasts are scanned at the same time   Axial   Ductal paths directly visualized in many images 3D fat-saturation DynaVIEWS   DynaVIEWS - MIP Restricted diffusion between cells caused by local cellular changes   May add specificity to breast MR   May be useful for monitoring chemotherapy patients RESOLVE is a diffusion weighted, readout-segmented EPI sequence optimized towards high-resolution imaging with reduced distortions. Features Sequence with very short echo-spacing   A 2D-navigator correction to avoid artifacts due to motion-induced phase errors   Diffusion-weighted imaging with a high level of detail and spatial resolution for breast imaging   Key Features AutoCoverage (AutoFoV & AutoSlice) adapt to individual patient   Implant type guidance and selection   Optimized shim volume   Strategies and Guidance   Biopsy Support Coronal STIR imaging for lymph nodes   Use body coil or spine coil GeneRAlized breast speCtroscopy Exam Breast acquisition protocols   SVS Spin Echo sequence   Choline – Breast Spectroscopy biomarker   Improved sensitivity and specificity for tumor diagnosis   Optimized for Siemens Breast matrix coil   Equipped with reference probe for lesion quantification Breast MRS Water and lipid signals suppressed   Visualization small choline peak   Water and lipid peaks seen in breast spectra are residual signals   Residual water peak reference set 4.7 ppm   Choline should be seen – 3.24 ppm   Illustrated in spectrum Residual Water Choline Water Residual Lipid Choline Post Processing Subtraction   Uneven fat-sat and background tissue removal   MIP   Soft Tissue Curves   Use mean curve   Position ROI over lesions and normal tissue using all measurements – = Measurement 2   Measurement 1   Subtraction 2 min sub SAG MPR of 2 min sub Full MIP of 2 min sub MIP of Axial 3D DynaVIEWS after subtraction   Infiltrating ductal CA   Pre 2 min Lesion Breast Tissue syngo BreVis syngo.via BreVis or syngo.via Breast Third Party Post Processing Case Studies 37 year-old   T2 TIRM T1 3D FLASH T2 TSE MIP of T1 3D FLASH 56 year-old   T2 TIRM T1 3D FLASH T2 TSE MIP of T1 3D FLASH Pre-Chemotherarpy Post-Chemotherapy You now should be able to: Define clinical indications Identify coils Perform patient preparation and breast imaging Identify sequences for breast imaging Demonstrate post processing data High Spatial Resolution Delayed VIEWS Axial or Sagittal Plane High Resolution Depending on the case:   Unilateral sagittal on effected side:  known cancers   Bilateral axial:  for screening, unknown disease   Very high resolution   Centric re-ordered k-space   Water-excitation   Less interpolation DCIS RESOLVE is a diffusion weighted, readout-segmented EPI sequence optimized towards high-resolution imaging with reduced distortions. Features Sequence with very short echo-spacing   A 2D-navigator correction to avoid artifacts due to motion-induced phase errors   Diffusion-weighted imaging with a high level of detail and spatial resolution for breast imaging

  • MAGNETOM Aera
  • Avanto
  • Espree
  • Skyra
  • Symphony
  • Trio
  • Verio
  • ESSENZA