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