Target Volume Determination 2015

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StefanDelorme Division ofRadiology

Sequences

Outline

Signs of breast cancer at MR mammography

21.05.14 |

• Must:

• Types of breast cancer • Imaging methods and features • Mammography • Ultrasound • CT • MRI • T stages • Nodal drainage and N Stages • Treated breast cancer

• Focal contrast enhancement • Early rise in intensity + plateau or washout • Contrast enhancement from periphery to center • Shape and architecture like in mammography or US

• T2w

• STIR (fat-suppressed T2) • T2 TSE

• T1 dynamic

• 3D-FLASH (104 slices, 0.8x0.6x1.5 mm, 5x3 min) • 0.2 mmol/kg BW Gd-DTPA

• Optional: • DWI

• Silicon-sensitive for Implants • Fat-suppressed T1w

StefanDelorme Division ofRadiology

Be aware of benign lesions

Weightings • T1

High versus Low Resolution

21.05.14 |

• Multiple small contrast enhancing spots (starry sky) ➡ Benign proliferative changes = normal • Smooth, enhancing tumors ➡ Mostly fibroadenomas • Bean-shaped, enhancing lymph nodes ➡ Intramammary lymph nodes • Cysts with enhancing wall ➡ Inflammatory reaction • Complex lesions with contrast enhancement post-op ➡ Fat necrosis ➡ Look for fat or hemoglobin degradation products

• Sensitive for susceptibility (blood, electro-coagulators, clips, large calcifications) • For post contrast imaging

• T2

• Cysts • Edema

• Lymph nodes • Fatty secretion • Implants

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