MRI BREAST BILATERAL W WO CONTRAST

DATE OF EXAM: 6/13/2016 5:19 PM

INDICATION: Breast ca s/p neoadjuvant chemo; C50.812 stage III B invasive
lobular breast cancer left breast. Status post neoadjuvant chemotherapy.
Presurgical evaluation.

TECHNIQUE: Bilateral breast magnetic resonance imaging was performed without
and with intravenous contrast using high resolution dynamic imaging on a 1.5
Tesla scanner. The examination was performed using a dedicated breast coil with
dynamic pre and post-contrast imaging. Computer aided evaluation was performed
using CADstream technology on an independent workstation. This includes motion
registration, multiplanar reformatted imaging, and kinetic enhancement
evaluation. The following pulse sequences were obtained: 1) Axial T2 FSE with
chemical fat saturation (FS); 2) Axial 3D T1, dynamic high resolution 3D T1
multiphasic images with FS (VIBRANT); 3) Axial subtraction images; 4) Post
gadolinium sagittal and axial 3D FSPGR T1 images with FS.

CONTRAST: The patient received 8 mL of Gadavist intravenous contrast.

COMPARISON: MRI of the breasts from February 2, 2016

FINDINGS:

There is mild background parenchymal enhancement in both breasts.

Right breast: There are unchanged mildly complicated appearing cysts with
intrinsic T1 shortening and no significant enhancement. This likely represents
proteinaceous debris. These are unchanged in size including a 1.3 cm cyst at the
anterior 12:00 position and a 1.1 cm cyst at the anterior 9:00 position. There
is also mild duct ectasia. There is no enhancing mass or area of nonmass-like
enhancement within the right breast.

Left breast: There is marked decrease in regional nonmass-like enhancement
previously encompassing nearly the entire outer left breast. There is a biopsy
clip positioned at the upper outer left breast at mid depth. Just posterior to
the clip, there is mild residual nonmass-like enhancement extending posteriorly.
There is also subtle nonmass-like enhancement extending posteriorly and
inferiorly at the outer and outer lower breast. The enhancement now shows no
worrisome kinetics without rapid enhancement. There is no residual worrisome
kinetic enhancement. The residual nonmass-like enhancement is very difficult to
measure in size. The most significant residual component within the upper outer
breast measures approximately 2.9 cm in length and 1.9 cm in craniocaudal
dimension. This similar area measured approximately 4.7 x 2.9 cm on the
comparison study.

There has been near complete resolution of level 1 left axillary adenopathy.
There is a very small residual level 1 left-sided axillary node which measures
up to 0.4 cm in short axis. There are no significantly enlarged or
morphologically worrisome right axillary lymph nodes.

There are no enhancing bony lesions.