WOMEN_IMAGING-CASESEssssssssssdsssssssssdssssssssss.pptx

Women imaging cases

1. WOMEN’S IMAGING HOW TO INTERPRET CASES

2. Birads classification BIRADS 0 : incomplete, further imaging or information is required, e.g. compression, magnification, special mammographic views, ultrasound. This is also used when requesting previous images not available at the time of reading . BIRADS I : negative, symmetrical and no masses, architectural disturbances or suspicious calcifications present.

3. Birads classification BIRADS II : benign findings, interpreter may wish to describe a benign-appearing finding, e.g. calcified fibroadenomas multiple secretory calcifications fat containing lesions such as  oil cysts breast lipomas fibroadenolipoma  or mixed density  hamartomas galactoceles    simple breast cysts these all should have characteristic appearances, and may be labeled with confidence; the interpreter might wish to describe intra-mammary lymph nodes, implants, etc. while still concluding that there is no mammographic evidence suggesting malignancy

4. Birads classification BIRADS III : probably benign , short interval follow-up suggested BIRADS IV : suspicious abnormality there is a mammographic appearance which is suspicious for malignancy biopsy should be considered for such a lesion these can be further divided as BIRADS IVa : low level of suspicion for malignancy BIRADS IVb : intermediate suspicion for malignancy BIRADS IVc : moderate suspicion for malignancy BIRADS V : there is a mammographic appearance which is highly suggestive of malignancy, action should be taken. BIRADS VI : known biopsy proven malignancy 

5. Breast cases

6. CASE 1

7. CASE 2

8. CASE 3

9. How to interpret breast calcifications

10. How to interpret breast calcifications

11. How to interpret breast calcifications

12. CASE 4

13. CASE 5

14. CASE 6

15. If you think everything well defined is benign reconsider Intracystic papilllary carcinoma. Invasive papillary carcinoma. Medullary carcinoma. Mucinous carcinoma. Metaplastic carcinoma.

16. CASE 7

17. CASE 8

18. CASE 9

19. Spectrum of imaging findings in an oil cyst

20. Spectrum of imaging findings in an oil cyst

21. Spectrum of imaging findings in an oil cyst

22. CASE 10

23. CASE 11

24. Criteria of intraductal papilloma Prsentation : bloody or serosanguinous  nipple discharge of less than 6 months duration .   Papillomas often present in the subareolar region. They arise within 1 cm from the nipple in 90% of cases. Those that are present in peripheral ducts away from the nipple have greater incidence of malignancy .   Papillomatosis of the breast is considered a premalignant condition.

25. MR ductography

26. Would you like to know how a lesion looks on contrast enhanced mammography?

27. Would you like to know how a lesion looks on contrast enhanced mammography?

28. Would you like to know how a lesion looks on tomosynthesis ?

29. Would you like to know how a lesion looks on tomosynthesis ?

30. Would you like to know how a lesion looks on sonoelastography ?

31. Would you like to know how a lesion looks on sonoelastography ?

32. CASE 12

33. Male breast

34. gynaecomastia Soft. Mobile. Tender. Subareolar .

35. CASE 13

36. CASE 14

37. Breast mri

38. ADC value = 0.84 CASE 15

39. ADC value = 1.09 CASE 16

40. ADC value = 0.96 CASE 17

41. CASE 18

42. What to search for in malignancy on mri Hypointense T2 signal Spiculated margins Blooming sign Hook sign Perifocal edema

43. CASE 19

44. CASE 20

45. CASE 21

46. CASE 22

47. DWI of the BREAST

48. Recent MR tools in breast imaging DTI: Qualitatively assess ductal orientation and pattern through direction maps. Quantitatively verify even minor distortions in architecture through ADC, FA and MD values.

49. Recent MR tools in breast imaging DTI:

50. Recent MR tools in breast imaging SWI: Detection & assessment of breast calcifications.

51. Recent MR tools in breast imaging MR elastography :

52. gynaecological cases

53. Adnexal lesions

54. MRI protocol: 1- High-resolution, T2W sequence without fatsat , in at least 2 planes -> anatomy 2- T1W sequence without fatsat , or preferably a T1W opposed-phase sequence -> detection of fat, in teratoma 3- T1W sequence with fatsat -> mainly for the identification of blood products and for correlation to post-contrast T1W images 4- A Proton-Density or T1W sequence extending to the upper abdomen -> nodal disease. 5- A T1W sequence with fatsat after administration of Gadolinium -> enhancement of solid lesions or lesion components. 6- A pelviabdominal diffusion-weighted sequence with a highest b-value of 500- 1000 s/mm2 -> detection of lymph nodes and detection of peritoneal deposits.

55. How to interpret mr signal

56. Normal ovaries

57. pco Imaging criteria: 10 or more peripheral simple cysts Usually Characteristic 'string-of-pearls' appearance. Ovaries are typically enlarged, although in 30% of patients the ovaries have a normal volume.

58. Haemorrhagic ov cysts

59. Dermoid cyst

60. endometrioma

61. What to search for in a case of endometriosis Extra ovarian solid endometriotic implants. Endometrioid ovarian cancer.

62. Mucinous cystadenoma

63. Mucinous cystadenocarcinoma

64. Role of mri in staging ovarian cancer

65. Uterine lesions

66. Role of mri in endometrial/cervical carcinoma Depth of myometrial invasion. Detect cervical stroma invasion. Distant spread.

67. Depth of myometrial invasion.

68. Detect cervical stroma invasion.

69. Extent of spread in cervical cancer.

70. Radiological appearances of uterine fibroids

71. adenomyosis

72. adenomyosis Abnormal thickening of the junctional zone (more than 12 mm). Foci of bright signal on T1W/T2W images corresponding to islands of hypertopic endometrial glands, crypts/cystic dilatation of hypertopic glands or foci of haemorrhage .

73. Thank you