Dr. Stough (left) joined RODEO MRI pioneer, Dr. Steven Harms (right) in a trip to Taiwan, training radiologists in the interpretation of breast MRI

Dr. Carol O'Dell is a breast-dedicated radiologist who serves as Assistant Clinical Director of Breast MRI of Oklahoma

Fig 3 (left)
Ductal carcinoma in Situ (DCIS)

While often called “early” breast cancer, DCIS can still spread throughout the ductal system and be more difficult to eradicate from the breast than many invasive cancers. Calcium is best detected on mammography, and it often leads to DCIS, but the extent of disease is frequently underestimated. In addition, many DCIS lesions do not develop calcium at all. Once again, Breast MRI is proving to be a very helpful adjunct in the detection of DCIS. In this patient’s breast, the DCIS forms both patchy and linear enhancements, and the problem proved to be much more extensive than believed from mammography alone.
 

Fig 4a (left) and 4b (right)
Axillary Adenopathy with Unknown Primary

This patient presented with an enlarged lymph node in her axilla (left: arrow) that proved to harbor metastatic cancer cells. While breast is the most likely site of origin, it is not always true, and this patient’s mammograms were normal. In years past, women presenting with malignant axillary nodes would undergo “blind” mastectomy, and it was not unusual for the breast to be normal on pathology exam (or, to find a small cancer that could have been handled easily with lumpectomy). Today, with breast MRI, one can see how clearly the subtraction view (right) shows a multifocal cancer (arrows) that was invisible on routine imaging studies.
 

(left to right) Fig 5a, Fig 5b, and Fig 5c
Extent of Cancer Grossly Underestimated by Mammography and Ultrasound.

Mammograms were low density in this patient, so when “invasive ductal carcinoma” was diagnosed from a solitary mass lesion, mammograms were felt to have accurately mapped the tumor pre-operatively. Ultrasound further confirmed a small, solitary tumor, so lumpectomy was advised and performed on the left breast. However, the surgeon was unable to obtain clear margins around the tumor after several attempts, so the procedure was ended, and breast MRI performed. In Figure 5a, one can see the large lumpectomy cavity (small arrows outline the bright fluid in the cavity), while an extensive area of residual cancer remains (large arrow). This residual cancer is best seen in the subtraction view (Figure 5b) as it extends throughout a large area (arrow) of the breast. However, the opposite breast (Figure 5c) had several areas of suspicious enhancement as well (arrow shows one example in the upper outer quadrant). Final diagnosis after bilateral mastectomy: extensive infiltrating lobular carcinoma, involving multiple quadrants in both breasts.