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It has a widely varied mammographic appearance, ranging from a focal asymmetry to a mass with
ill-defined or spiculated margins. What are the next steps with abbreviated MRI, and what needs to
happen to move things forward. The pre-contrast T1-weighted sequence is typically used to assess
the amount of fibroglandular tissue and can be particularly helpful in documenting the presence of
high-signal hemorrhagic or proteinaceous fluid-filled, dilated ducts (Fig. 1.1 ). Radiologists should be
aware of these T1-hyperintense ducts, which can cause potential misregistration artifact related to
patient motion, leading to an apparent suspicious linear nonmass enhancement on post-contrast
subtracted images. A radiologist or trained doctor will analyze the images and send the report to your
doctor, who will share the results with you. Related Content: Abbreviated MRI: Guidance On
Implementation For Breast Cancer Screening Diagnostic Imaging: What about the challenges around
clinical implementation. Both technologies are capable of producing detailed three-dimensional
images, and. Kelly-Anne Phillips MBBS MD FRACP CCV Colebatch Clinical Research Fellow
Medical Oncologist Peter MacCallum Cancer Centre. Background. Approx 13,000 Australians
diagnosed each year. Larger displacements have been observed, but these were mostly transient. This
can lead to a larger CTV in the adjuvant setting than would have been necessary in the neoadjuvant
setting. Second, the influence of geometric accuracy of the MR images on treatment planning must
be considered. Its sonographic features also vary widely from benign-appearing masses with
circumscribed margins and acoustic enhancement to malignant-appearing masses with spiculated
margins and acoustic shadowing. A summary of online available MRI sequences on hybrid machines
is presented in Table 2. In general, it is expected that a full reoptimization plan adaptation method
will lead to improved dosimetry in most patients, especially in the case of deformations in the tumour
or OARs, but will take more time ( 78, 79 ). Breast implants are commonly positioned either deep.
Radiologists want to know they are providing value to the patient by offering abbreviated breast
MRI. It showed rapid initial enhancement with delayed washout kinetics. That’s really where we
think abbreviated MRI could help. The two diffusion encoding gradients ( G diff ) are matched and
with same polarity. Rarely, skin necrosis can develop over a rapidly growing lesion. Just saying you
are going to cut the exam time down by offering abbreviated breast MRI is a great first step.
Exponential fits using two different high b values are shown ( dotted lines ), demonstrating the ADC
dependence on the b value used to acquire DWI data. Dr. Sethi is Editor-in-Chief of Internet Journal
of Radiology. Other names, such as fibroadenolipoma or lipofibroadenoma have been used to reflect
the dominant tissue types within the mass. Collins Medicine Modern Pathology 2020 TLDR Not
only is there the imperative for accuracy and precision of core needle biopsy diagnoses, increasingly
it is the only opportunity for that diagnosis. In the series of Jones and associates, most lesions
present as clumped nonmasslike enhancement, in focal or segmental distributions ( Figure 7.13 ).
Nodular PASH may appear as a small irregular mass ( Figure 7.14 ). FIGURE 7.13
Pseudoangiomatous stromal hyperplasia is seen in a 35-year-old woman with a prior left mastectomy
for rhabdomyosarcoma. Hence, they recommend thorough histologic evaluation of biopsy specimen
demonstrating PASH, with clinical and radiologic follow-up. However, voxels with high T2 values
have intrinsically high signal compared to the background, which propagates to the high b -value
DW image and mimics the appearance of cancer ( Fig. 11?4 ). This effect is called “T2 shine-
through” and can lower the diagnostic value of the DW images. For example, if your breast MRI slot
at your practice is usually one hour, maybe you could perform three abbreviated MRIs in that same
one-hour time period. Selected sagittal T1 pre-contrast image ( c ) right breast demonstrates
heterogeneous fibroglandular tissue. According to van Heijst et al. ( 60 ), the mean skin dose
increased from 29.5 Gy at 0 T to 32.3 Gy at 0.35 T and to 33.2 Gy at 1.5 T for 2-beam WBI. For 7-
beam WBI, the mean skin dose increased from 27.9 Gy at 0 T to 30.2 Gy at 0.35 T and to 29.8 Gy at
1.5 T. Given these findings, WBI is not thought to be a good indication for treatment on a hybrid
machine, irrespective of the field strength.
Coarse calcifications, when present, may be diagnostic. Therefore, it is necessary to develop
dedicated RT immobilization equipment that is MR-compatible (i.e., non-conductive, low-density
material). These techniques have been studied in the context of breast lesion characterization, with
promising results. Despite its diagnostic challenges, GCT is usually benign and carries an excellent
prognosis. GCTs show medium or rapid rate of contrast enhancement during early phase, with either
persistent or washout kinetics in the late phase. A radiologist reviews selected abbreviated sequences
from a full exam and decides if they can find a breast cancer in these images. HiSS MRI is well
suited for this purpose, as it is sensitive in voxels with low water content, and able to selectively
visualize the parenchymal tissue without the use of fat-suppressing RF pulses that may affect water
signal as well. There have been early results, to date, that have been promising the for evaluation of
known cancers. Magnetic field dose effects on different radiation beam geometries for
hypofractionated partial breast irradiation. On MRI, ectatic ducts are usually incidental findings.
These individuals include MRI Technologists, Imaging Nurses, MRI Researchers, and Others.
However, some fibroadenomas are known to show rapid early enhancement with delayed washout
kinetics, mimicking malignancy ( Figure 7.12 ). FIGURE 7.12 Fibroadenoma is seen in a 33-year-old
woman with a strong family history of premenopausal breast cancer undergoing high-risk screening
breast MRI. Review expected range of normal functional anatomy of the breast, as seen on dynamic
contrast-enhanced images of the breast. Here is my attempt to explain the charm of this branch. A
minimum field strength of 1.5 T is recommended for optimal breast MR imaging. For breast cancer
patients, MR-guided RT is expected to be most beneficial in the neoadjuvant setting treating in situ
tumours, which can be more clearly visualized on MR images than on CT, both at the time of RT
planning and during RT treatment. If you haven't yet reached menopause, the MRI facility may
prefer to schedule your MRI at a certain time during your menstrual cycle, around days 5 to 15. It
has been described as a mass with either smooth or spiculated margins. This can lead to a larger CTV
in the adjuvant setting than would have been necessary in the neoadjuvant setting. B, Sagittal T1-
weighted fat-suppressed postcontrast image shows smooth lobular margins and internal
nonenhancing septations. In general, a higher field strength gives a better signal-to-noise ratio, which
may place a 1.5-T hybrid system in favour over a 0.35-T system. However, experiences with the
0.35-T hybrid system show that patient setup and online tracking for breast cancer could be
performed successfully based on imaging at this lower magnetic field strength ( 26 ). The images can
then be examined on a computer monitor, transmitted electronically, printed or copied to a CD or
uploaded to a digital cloud server. This issue still requires investigation in the context of PBI, such as
investigation of the impact of distortion at the edges of the breasts, which would lead to inaccurate
assignment of air vs. Asterisks indicate tissue that is not fully within the chambers of the coil. They
have the potential to provide complementary information on lesions identified on contrast-enhanced
screening MRI examinations, which can be used to rule out malignancy and thus increase the
accuracy of the examinations. Although multiecho gradient echo and sometimes EPSI sequences are
commercially available, at this time they are not implemented adequately for HiSS imaging.
Although there are many benign MR imaging findings that have increased T2 signal, such as cysts
and fibroadenomas, it is important to remember that malignant lesions can also have increased T2
signal. MRI is the best imaging modality for evaluation of chest wall invasion and extent of disease.
Susceptibility effects scale with the main magnetic field strength ( 31 ). A delayed axial postcontrast
series is also obtained for multiplanar reference purposes, as well as for delayed enhancement
information.
No problems are expected because of this because good plan quality for PBI can be achieved with
coplanar IMRT ( 26, 63, 68 ). Prescribing, recording, reporting photon-beam intensity-modulated
radiation therapy (IMRT). Letting a member of your team know about your allergies can help
prevent problems with the dye. Furthermore, it has been reported that increasing the number of beam
angles helps in decreasing the skin dose ( 60, 62 ). According to Teh and coworkers, hyperintense
fine reticular “lacelike” networks on T2-weighted images, thought to correspond to collagen strands,
may be a distinguishing MRI feature for tumoral PASH. The dye makes the tissues or blood vessels
on the MRI pictures easier to see. However, voxels with high T2 values have intrinsically high signal
compared to the background, which propagates to the high b -value DW image and mimics the
appearance of cancer ( Fig. 11?4 ). This effect is called “T2 shine-through” and can lower the
diagnostic value of the DW images. By utilizing noncontrast protocol and teleradiology, a similar
approach could be applied to screening breast MRIs. However, these solutions depend on how much
space you have in your practice and how much duplicate equipment you would have to purchase.
Breast Dot Engine for excellent implant imaging results Zoom Your benefits: Optimal timing of
dynamic scans Step-by-step user guidance Example images and guidance text are displayed for each
individual step Images and text are easily configurable by the user Biopsy planning software
(optional) displays target coordinates of the lesion on the inroom display directly at the scanner
Zoom Breast Biopsy Software Our new breast biopsy software is seamlessly embedded into the
scanner workflow. For that reason, the receiver coils dedicated to hybrid machines have a “window”
through which irradiation is possible ( 15, 25 ). Breast changes might include a buildup of unusual
cells in the breast, called atypical hyperplasia, or unusual cells in the milk glands of the breast, call
lobular carcinoma in situ. Instead, HiSS MRI has been implemented as a patch on Philips, GE, and
Siemens scanner consoles. The ability to cross-reference between planes is useful in establishing the
3-dimensional characteristics of any finding. The advantage of HiSS MRI over conventional fat
suppression methods is two-fold. If the breast MRI is being performed to check for a ruptured breast
implant, contrast dye will not be used. The initial results came out in February of this year. The
Reading Room Podcast: Emerging Concepts in Breast Cancer Screening and Health Equity
Implications, Part 2 August 23rd 2023 Podcast In the second episode of a three-part podcast, Anand
Narayan, M.D., Ph.D., and Amy Patel, M.D., discuss recent studies published by the Journal of the
American Medical Association (JAMA) that suggested moving to more of a risk-adapted model for
mammography screening. When symptomatic, a patient with PASH may present with a painless,
mobile mass (nodular PASH), frequently misdiagnosed as a fibroadenoma. After the examination is
complete, they take out the IV, clean the room, and turn it around for the next patient. With MR you
can see a lot more than with mammography or ultrasound. Radiologists also need to be aware that,
like all breast MRI, abbreviated breast MRI has high sensitivity and accuracy for invasive cancers
and high-grade ductal carcinoma in situ, but is less sensitive for low-grade DCIS. This entity will be
discussed in detail in Chapter 8. Diagnostic MRI: Breast Cancer Applications Chapter 11. Target
volume delineation in breast conserving radiotherapy: are co-registered CT and MR images of added
value. At this point, breast MRI screening is recommended for people who are at high lifetime risk of
breast cancer. You need to show the method to your PG teacher before you include this method in
your thesis. B, T1-weighted, fat-suppressed precontrast image shows the mass ( arrow ) to be
isointense in signal to normal parenchyma. PASH is usually an incidental microscopic finding in
breast biopsies with no mammographic correlate. Lowell General Hospital. “In this defining moment,
a change has come to Lowell General”.
But as with other tests, a breast MRI has risks, such as. This can potentially pose problems for
quantitative imaging. Elba Torres Matundan MD FCAP Victor Carlo Vargas MD FCAP. Your doctor
will have access to reports and images. It is considered a neoplastic process because of its ability to
recur. Prescribing, recording, reporting photon-beam intensity-modulated radiation therapy (IMRT). I
look forward to seeing the results of these large trials and hope they will help patients have better
access to this new screening tool. You should also drink plenty of water to help flush the contrast
material out of your body if it was used. You can also take a look at how your room is set up.
Additionally, to preventing the motion, artefact reduction (e.g., gating or triggering) or motion
correction (e.g., MR navigators) techniques can be used to minimize motion effects on MRI scans.
This includes people with a high risk of breast cancer. Its mammographic findings are nonspecific,
including spiculated mass, architectural distortion, or a benign-appearing circumscribed mass.
Furthermore, the TRE, in average, are about 1 cm, better than those exposed in previous works. MR
imaging can help provide early and reliable diagnosis especially in difficult cases. Stepoffs of tissue
between breast within and outside of the chamber are seen ( blue arrows ), created by the patient’s
weight on the breast. Breast MRI can provide quantitative 3D measurements of breast density and
glandular tissue volume, which would be of greater value in cancer risk management. It may form a
distinct nodule, hence the term nodular sclerosing adenosis or adenosis tumor. Mammographically,
sclerosing adenosis may present as clustered, round, or punctate microcalcifications; a focal
asymmetry; architectural distortion; or a spiculated mass. It must be noted that the pressure from the
patient’s weight on the portions of the breast excluded from the coil also alters the vascular flow
dynamics of those areas. To ensure appropriate image quality, the MRI sequences and image quality
for breast imaging on the hybrid systems should therefore be tested and optimized for the use of the
dedicated coil and each system specifically. There’s various reasons why that might be happening.
Currently, the main limitation of DWI is the low resolution necessary to achieve clinically realistic
imaging times. Use of diffusion-weighted imaging (DWI) was described in only one study, where it
was used in the context of response evaluation after RT and not for target delineation ( 35 ).
Diagnostic Imaging: How does abbreviated MRI compared to traditional MRI for the radiologist.
All sequences described were acquired on stand-alone MRI scanners. The lymphocytic infiltrate is
composed predominantly of B cells. Biopsy revealed pseudoangiomatous stromal hyperplasia.
Related Videos Related Content Advertisement MRI Research Suggests Link Between COVID-19
Related Brain Fog and Blood-Brain Barrier Dysfunction February 23rd 2024 Article For people with
COVID-19 related brain fog, emerging dynamic contrast-enhanced MRI (DCE-MRI) research
findings revealed blood-brain barrier disruption in multiple brain regions, including temporal lobes
and the frontal cortex, up to a year after active infection. HiSS MRI could be useful in achieving this
goal. Fig. 11.14 A 69-year-old woman with an invasive ductal carcinoma was imaged using HiSS
MRI (a) and conventional T1-weighted fat-suppressed postcontrast DCE-MRI (b). A less common
presentation is an echogenic area containing central linear hypoechoic areas or cysts.
It is hypointense in the ADC map (c), indicating its malignant nature. On MRI, ectatic ducts are
usually incidental findings. The biopsy is performed by Dr. Evelyn Wenkel University Hospital
Erlangen Erlangen, Germany Clinical Talks Outstanding presentations given by an international
luminary faculty. Thus, development of a non-contrast enhanced breast cancer screening MRI
protocol would be a significant advancement in breast cancer prevention. What is your diagnosis?.
CASE 1. A 48 year old female was found to have a lobular mass on routine mammogram. CASE 2.
The first big multi-center trial preliminary results have just come out, and they will be doing ongoing
analysis that will be important. Furthermore, they have recently been described in benign and
malignant phyllodes tumors and mucinous carcinoma and may be of limited value for diagnosing
fibroadenoma when considered alone. FIGURE 7.11 Fibroadenoma is seen in a 35-year-old woman
with a strong family history of breast cancer undergoing high-risk screening breast MRI. Evaluation
of the amount of FGT is usually done on the T1-weighted sequences with and without fat
suppression. A contrast dye can help to identify tumors and other abnormalities. A, Sagittal T1-
weighted postcontrast image with subtraction shows a 1-cm lobular mass ( arrow ) with irregular
margins and homogeneous enhancement. The effect of distortions on image quality is described in
this section, whereas the effect of distortions on dose distributions is described in Treatment
Planning for a Hybrid Machine. This makes differentiation from phyllodes tumor challenging in
some cases. All images are shown within the same field of view. Our dedicated reading and reporting
software syngo.MR BreVis is a computer-aided tool for real-time breast analysis. Biopsy revealed
fibrocystic changes. FIGURE 7.3 FCCs are seen in a 36-year-old woman with strong family history
of premenopausal breast cancer. That’s really where we think abbreviated MRI could help. A
possible solution may be to shift the patient on the scanner table toward the contralateral side such
that the ipsilateral breast moves closer to the machine isocenter, if this is possible within the limited
space inside the bore. That’s going to be less efficient for workflow and turnaround. We need to
know if these women can have an abbreviated breast MRI or a longer breast MRI. Light blue shapes
represent the receiver coils (horizontal: receiver coil array; vertical: single flex coil). There’s various
reasons why that might be happening. On T2-weighted sequences, high-signal cysts mixed with low-
to intermediate-signal stroma are reported. Guidelines for the delineation of primary breast tumours
on MRI for use in neoadjuvant PBI setting have recently been developed by the Breast Tumor Site
Group of the International MR-Linac Atlantic Consortium ( 36 ). No systematic review of the MRI
appearance of UDH is available in the literature. It was mildly signal hypointense on the
corresponding noncontrast image (not shown). Our breast coils are designed to provide high SNR for
excellent diagnostic image quality or to provide greatest access to the breast for interventions. This
and subsequent postprocessing described below are not currently performed on the scanner console,
though research options allow installation of custom postprocessing algorithms on consoles. Lobular
Neoplasia Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are relatively
uncommon lesions, collectively identified as lobular neoplasia. Dr. Mona Rozin Director of Breast
Imaging Assuta Medical Centers. In a small series of 11 cases studied by Chen and colleagues, 62%
of FCC showed early rapid enhancement with delayed washout, mimicking carcinoma. FIGURE 7.2
FCCs are seen in a 42-year-old woman with a recent diagnosis of right breast carcinoma.
Ultrasound shows a heterogeneously hypoechoic mass with ill-defined margins and marked posterior
acoustic shadowing. After recent reports of Gd deposition in tissue, including deep brain structures,
with repeated exposure to GBCM, 22,? 131 any population-wide breast screening programs will
almost certainly require imaging without contrast media injection. MRI guidance for accelerated
partial breast irradiation in prone position: imaging protocol design and evaluation. The first clinical
results showed good tolerability, low toxicity with a maximum of grade 2 toxicity, and good to
excellent cosmetic outcome assessed by both patients and physician ( 86, 87 ). As a result, in an
abbreviated MRI, we don’t acquire additional delayed post-contrast sequences. It also includes
people who have a strong family history of breast cancer or who have breast cancer gene changes
that were passed down through the family, called inherited. Integrating a MRI scanner with a 6 MV
radiotherapy accelerator: dose deposition in a transverse magnetic field. HiSS MRI could be useful
in achieving this goal. Fig. 11.14 A 69-year-old woman with an invasive ductal carcinoma was
imaged using HiSS MRI (a) and conventional T1-weighted fat-suppressed postcontrast DCE-MRI
(b). Selected sagittal T1 post-contrast image ( d ) left breast demonstrates extreme fibroglandular
tissue 1.4 Fibroglandular Tissue Teaching Points At mammography, breast density is represented by
the amount of fibroglandular tissue (FGT) in contrast to fat measured in two-dimensional views that
may not reflect an accurate assessment. It is common in younger women, affecting one third of
females 20 to 45 years of age. It has since been used for a variety of brain disorders, primarily white
matter disorders, as well as for monitoring therapy response in brain tumors. The diagnosis has
become more frequently encountered with increased use of screening mammography, sonography,
and breast MRI. In these cases, MRI is often used to monitor how well the chemotherapy is working
and to reevaluate the amount of tumor still present before the surgery is performed. However, there
are some specific issues to highlight that will be different from treatment planning for breast
irradiation on a conventional linac. Thus, synthetic DW images obtained via extrapolation from lower
b values should be clearly identified and distinguished from DW images that were truly acquired at a
very high b value. It typically shows benign persistent enhancement curves in the delayed phase (
Figure 7.19 ), although plateau and washout kinetics have been reported. Although challenges for
treatment of breast cancer patients on these systems remain ( Table 1 ), the first breast cancer patients
have been treated successfully with adjuvant PBI on a hybrid system, and studies of MR-guided
neoadjuvant PBI will open shortly, through which technical approaches and workflow are likely to
be further refined. Inclusion of bone density information, specifically the spine in this study on lung
tumour treatment plans, proved to be important to reduce local hot spots in the differences between
the simulated dose distributions on CT and synthetic CT ( 73 ). All spectra are on the same scale and
referenced to the same carrier frequency and the water (w) and fat (f) peaks are labeled. Gadolinium
nanoparticles and contrast agent as radiation sensitizers. The lower cost would also figure in more
general cost-benefit analyses, possibly enlarging the pool of women who would be offered and could
benefit from MRI screening. 11.4 Diffusion-Weighted Imaging 11.4.1 Introduction to Diffusion-
Weighted Imaging The first applications of diffusion-weighted imaging (DWI) came in the 1990s, in
the differential diagnosis of ischemic versus hemorrhagic acute stroke. While the water peak integral
image shows higher signal-to-noise ratio and lower artifact level water peak height image shows
better contrast and internal structure definition in the parenchyma and in the IDC lesion in central
right breast. B, There is no enhancement of the walls or contents of the cysts on the postcontrast fat-
suppressed T1-weighted image. FIGURE 7.7 An inflammatory cyst is seen in a 49-year-old woman
with a history of lumpectomy for tubular carcinoma of the right breast who underwent 6-month
postoperative follow-up MRI. Rarely, diffuse PASH may necessitate mastectomy for symptomatic
and cosmetic indications. In addition, ADC values of ductal carcinoma in situ (DCIS) are
intermediate and have significant overlap with both benign and malignant ADC value ranges. 79,?
81 Thus, despite generally high diagnostic performance, DWI does suffer to a degree from low
specificity for cancer and low sensitivity to DCIS. Some benign lesions, however, are simply
indistinguishable from malignancy on imaging, and biopsy is necessary for histologic diagnosis. With
MR you can see a lot more than with mammography or ultrasound. There are few reports of the MRI
appearance of GCT. The patient is positioned prone, with the breasts pendant in the dedicated breast
coil. Maybe you could increase turnaround time with duplicate breast coils with one patient being
scanned while you’re positioning the next patient to be ready to go.
Figures 7-20 and 7-21 are examples of GCTs identified on MRI. FIGURE 7.20 A GCT is shown in
an axial postcontrast subtraction MRI image. The 2D problem consists of directly projecting the
landmark position from the MRI to the mammogram, computing the Euclidean distance between the
computed and the real landmark position. There have been a variety of ways outpatient centers or
hospitals have sought reimbursement for abbreviated MRI. Let us help you reach your goals on the
scale, starting with a Body Composition scan. Zoom Applications for contrast dynamics VIEWS:
Volume imaging with enhanced water signal VIEWS provides isotropic 3D imaging protocols with
high temporal and spatial resolution as well as excellent fat suppression. This issue still requires
investigation in the context of PBI, such as investigation of the impact of distortion at the edges of
the breasts, which would lead to inaccurate assignment of air vs. If you haven't yet reached
menopause, the MRI facility may prefer to schedule your MRI at a certain time during your
menstrual cycle, around days 5 to 15. The primary outcomes of these trials are postoperative
complication rate, reproducibility of treatment, and pathologic response, respectively. Their signal
intensity follows that of normal fatty tissue in the breast on all sequences. Our model reduces the
search space until 600 times with respect to a traditional point-by-point search. The Reading Room
Podcast: Emerging Concepts in Breast Cancer Screening and Health Equity Implications, Part 3
September 1st 2023 Podcast In the third episode of a three-part podcast, Anand Narayan, M.D.,
Ph.D., and Amy Patel, M.D., discuss the challenges of expanded breast cancer screening amid a
backdrop of radiologist shortages and ever-increasing volume on radiology worklists. Some women
might benefit from breast MRI, including those who have dense breasts. Although it's a good test, a
breast MRI can still miss some breast cancers that a mammogram will find. In the group reporting on
adjuvant PBI on a 60 Co system, where online MRI proved beneficial for setup and PTV margin
reduction, no online plan adaptation was performed, and yet retrospective comparison of planned vs.
Enhancement appears heterogeneous on published images, with delayed persistent kinetics ( Figure
7.15 ). FIGURE 7.15 PASH is shown in tumoral form. C, The dark septations are also visible on a
sagittal T2-weighted fat-suppressed image. The ADC value thus calculated is lower still, as it
excludes perfusion effects and more closely represents the true rate of diffusion in the tissue. Usage
of this system resulted in benefits for initial patient setup on lumpectomy cavity and online motion
monitoring by which the PTV margin was diminished to 0 mm, which led to a large reduction in
treatment volume of 52% ( 26, 43, 69, 75 ). It is considered a neoplastic process because of its ability
to recur. On MRI, a fibroadenoma typically appears as an oval mass with smooth margins. The
images show three different patients. (A) No space for the receiver coil on the back of the patient if
the breast hangs freely without touching the scanner table; (B) the receiver coil fits above the patient
while also the breast hangs freely; (C) when the receiver coil is fitted in the MRI bore above the
patient, the breast touches the table top and is deformed. From Glazebrook KN, Renolds CA:
Mammary Fibromatosis, AJR Am J Roentgenol 193:856-860, 2009) Granular Cell Tumor Granular
cell tumor (GCT) is a tumor of Schwann cell origin that may occur at any body site, involving the
breast in 6% to 8% of cases. Top right: Three of the original cancer cells have survived to begin
replicating. One of these is the ERE, which refers to the fact that the path of electrons is bent in the
presence of a magnetic field, resulting in exit electrons re-entering the body after a helical path in air
( 55 ). Such effects are variable and difficult to model, which presents challenges for quantitative
image analysis, but are avoided in HiSS MRI. Signal-enhanced data can be used to evaluate potential
tumor vascularization. The user simply tailors the exam to each individual patient, i.e., depending on
the presence of implants, and defines the scanning approach. Diabetic Mastopathy Diabetic
mastopathy is a condition in which stromal proliferation forms fibrous masses, predominantly in
female patients with long-standing insulin-dependent (type 1) diabetes mellitus. It was initially
reported in a patient with Gardner syndrome but may occur sporadically or after trauma or surgery.
Standardization would allow future inclusion of DWI characteristics in BIRADS description of
breast lesions.