Breast MRI for Equivocal Mammographic Findings

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 17, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 1.00
Patient Care: 1.00
Patient Interactions and Management: 1.00

Mammography: 2.00
Procedures: 2.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Body: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Thoracic Section: 2.00

Outline

1. Introduction
2. Diagnostic Mammographic Evaluation
3. Diagnostic US Evaluation
4. Problem-Solving MR Imaging
   1. The One-View Finding
   2. Technical Differences versus True Change in a Lesion
   3. Biopsy Challenges
      1. Limited Biopsy Options
      2. Concordance Issues
   4. Diagnostic Situations Where MR Imaging May Be Unhelpful
   5. False-Negative and False-Positive Breast MR Imaging
   6. American College of Radiology Recommendations
5. Conclusion

Objectives

Upon completion of this course, students will:

1. understand the uses of diagnostic MR imaging for lesions
2. describe the MR imaging role for localizable breast findings
3. explain how often diagnostic MR imaging is used for uncertain mammographic findings
4. state the percentage of mammograms in the Moy et al study that were equivocal and referred for problem-solving MR imaging
5. explain when the technique of spot compression should be performed
6. express the type of pressure needed for spot compression views
7. state which imaging modality is likely to reduce the number of diagnostic views needed to evaluate potential lesions
8. recall which imaging modality is the mainstay for the diagnosis of non-calcified mammographic findings
9. list pathologic conditions in which targeted ultrasound may not show a correlate to a mammographic finding
10. list non-pathologic factors that can influence the detection of an ultrasound correlate
11. list the studies that have evaluated diagnostic MR imaging for various problematic mammographic findings
12. reiterate the number of problematic lesions reported on by the Lee et al study
13. select the study that included outcomes based on suspicious mammographic or ultrasound findings for MR imaging
14. associate summation artifacts with one projection mammographic images
15. relate low density one-view mammographic findings to stereotactic biopsy targeting
16. list the benign histologic findings that occur commonly, may be found incidentally, and make radiologic-pathologic concordance uncertain
17. list the technical factors that may contribute to lesions being called equivocal
18. explain how the change in patient factors affects the appearance of breast tissue
19. list the factors that can affect the appearance of the lumpectomy bed at mammography
20. state the imaging modality that is useful for distinguishing local recurrence from post-treatment changes in breast tissue
21. choose the best diagnostic procedure when a significant breast lesion is suspected
22. list the benefits of ultrasound guided core biopsy
23. state how blood or lidocaine may affect stereotactic breast biopsies
24. state the best patient position for biopsy of posterior breast lesions
25. define “doubling down”
26. explain the diagnostic situations in which breast MR imaging is NOT helpful
27. recall the most sensitive breast imaging modality for the detection of invasive breast malignancies
28. explain how invasive breast cancer enhances on MR breast imaging
29. state how DCIS typically manifests at mammography
30. list the study on problem-solving MR imaging that reported no false-negative malignancies
31. state the likelihood of incidental lesions appearing on problem-solving MR imaging
32. explain how enhancing lesions may lead to follow-up MR imaging
33. state the current edition of the ACR BI-RADS Mammography Altas
34. state the ACR BI-RADS edition that discourages the use of BI-RADS “0” when MR imaging is recommended
35. review the management algorithm for appropriate use of problem-solving MR imaging for mammographic lesions