Download Free Medical Breast Imaging Modalities PowerPoint Presentation

Breast Imaging Modalities PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Radiology and Imaging, which is titled "Breast Imaging Modalities", to know about different Breast Imaging Modalities.

Tags : Radiology, Imaging, Breast Imaging Modalities

Published on : Aug 02, 2021 | Views : 2746 | Downloads : 10

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Breast Imaging Modalities Dr. Y. Madhu Madhava Reddy
Slide 2-

Mammography A mammogram can find breast cancer when it is very small -- 2 to 3 years before patient can feel it. No screening tool is 100% effective. Good quality mammograms can find 85-90% of cancers
Slide 3-

Routine Images - aka “screening mammo’’ Positions CC - cranio caudal MLO – mediolateral oblique
Slide 4-

ppt slide no 4 content not found
Slide 5-

ppt slide no 5 content not found
Slide 6-

Positioning of Breast for CC View
Slide 7-

ppt slide no 7 content not found
Slide 8-

ppt slide no 8 content not found
Slide 9-

ppt slide no 9 content not found
Slide 10-

ppt slide no 10 content not found
Slide 11-

ppt slide no 11 content not found
Slide 12-

ppt slide no 12 content not found
Slide 13-

ppt slide no 13 content not found
Slide 14-

ppt slide no 14 content not found
Slide 15-

ppt slide no 15 content not found
Slide 16-

ppt slide no 16 content not found
Slide 17-

ppt slide no 17 content not found
Slide 18-

ppt slide no 18 content not found
Slide 19-

ppt slide no 19 content not found
Slide 20-

ppt slide no 20 content not found
Slide 21-

ppt slide no 21 content not found
Slide 22-

ppt slide no 22 content not found
Slide 23-

ppt slide no 23 content not found
Slide 24-

ppt slide no 24 content not found
Slide 25-

ppt slide no 25 content not found
Slide 26-

ppt slide no 26 content not found
Slide 27-

ppt slide no 27 content not found
Slide 28-

ppt slide no 28 content not found
Slide 29-

ppt slide no 29 content not found
Slide 30-

ppt slide no 30 content not found
Slide 31-

ppt slide no 31 content not found
Slide 32-

ppt slide no 32 content not found
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found
Slide 35-

ppt slide no 35 content not found
Slide 36-

GALACTOGRAPHY / DUCTOGRAPHY Breast ductography is an imaging technique which is used to evaluate lesions causing nipple discharge. It helps in precisely locating the mass within breast tissue and gives useful information for surgical approach and planning.
Slide 37-

Indications and Contraindications The most common use of galactography is to evaluate a woman who has a unilateral bloody or clear discharge from her breast nipple and an otherwise normal mammogram. Galactography is typically NOT called for in women with the following conditions: A discharge that is milky, yellow, green, or gray is usually not a cause for concern, especially if it comes from multiple ducts in the breast. A discharge that is from both breasts in a woman who has not had children may indicate a side effect from a drug, or may be related to a pituitary etiology.
Slide 38-

Technique A blunt-tipped sialogram needle (30-gauge) is used for performing ductogram. The abnormal duct is identified and cannulated. Approximately 3 ml of contrast is injected into the duct and canula is taped to the nipple. A standard two view mammography (or CC and ML projections) are obtained. Ductal filling defects are generally caused by papilloma or DCIS.
Slide 39-

Filling defects d/t intraductal Carcinoma
Slide 40-

X ray guided Procedures Stereotactic guided FNAC: For lesions that are not seen or are poorly visualised on ultrasound, mammographic guidance is required for needle biopsy. The most common method currently in use is an add-on stereotactic device which is used with a conventional upright mammography machine.
Slide 41-

Technique The lesion is demonstrated on paired stereotactic views obtained with the X-ray tube angled 15° either side of the central tube position. Measurements defining the position of the lesion on the stereotactic views are used to determine the position of the needle guide in the X, Y and Z axes. When the needle, of specified length, has been inserted through the guide into the breast, check stereotactic views are obtained to ensure that the tip of the needle is correctly positioned in relation to the lesion. If the position is not correct, the needle can be repositioned and further check films obtained.
Slide 42-

Different parts of the lesion are sampled by moving the needle guide 2-3 mm in the X andY axes. Up to five aspirates are usually obtained.
Slide 43-

Stereotactic guided Core biopsy Conventional mammography with add on stereotactic equipment and analogue imaging can be used for stereotactic core biopsy. More accurate results are obtained using dedicated prone stereotactic biopsy equipment with digital imaging.
Slide 44-

Technique Using this equipment, the patient lies in the prone or prone oblique position and the breast passes through an aperture in the table. The direction of the X-ray beam is horizontal and stereotactic views are obtained by rotating the tube 15° either side of the central position. The digital X-ray images obtained are displayed on a computer screen within approximately 5 seconds of exposure, and the computer offers rapid contrast adjustment and zoom features.
Slide 45-

Stereotactic guided core biopsy
Slide 46-

Stereotactic guided core biopsy Target areas for biopsy are selected on the computer screen and the position and angulation of the biopsy needle/gun holder are adjusted automatically. A 14G needle is used; after insertion under local anaesthetic, check films are taken to ensure correct positioning . Check films can also be taken after firing the biopsy gun to ensure that the lesion has been traversed by the needle. Five or more core biopsies are usually obtained. Core biopsy specimen radiographs are taken when sampling areas of microcalcification to ensure that representative tissue has been obtained
Slide 47-

Stereotactic guided core biopsy
Slide 48-

Vaccum Assisted Core Biopsy This procedure allows a larger tissue sample to be obtained. An I I G probe with a biopsy port attached to a vacuum-producing device is inserted into the breast under local anaesthetic and stereotactic guidance. Tissue from the target area is sucked into the biopsy port by the vacuum and is then separated from the surrounding breast by a rotating cutting cylinder which passes down within the probe.
Slide 49-

Vaccum Assisted Core Biopsy The tissue sample is then delivered by withdrawing the cutting cylinder-the probe is left in position in the breast and is rotated so that the biopsy port is aligned with the next site for sampling and in this way multiple samples are taken and small clusters of micro calcification are usually completely removed.
Slide 50-

ppt slide no 50 content not found
Slide 51-

Vaccum Assisted Core Biopsy If the mammographic marker is removed, a small metal clip / gel pellets or combined gel-metal (USG Sensitive) markers are deployed at the site of the biopsy to allow accurate localisation should subsequent surgical excision be necessary. Vacuum-assisted core biopsy has also been used under ultrasound guidance for sampling of soft tissue lesions, and under MRI guidance for lesions which are not visible using either mammography or ultrasound.
Slide 52-

Core specimen radiography. A specimen radiograph showing a good yield of microcalcifications in several vacuum-assisted mammotomy biopsy cores.
Slide 53-

Preoperative localisation of Non palpable lesions For the non palpable breast lesions the position of the lesion is marked using a wire with a hook or barb on the end to prevent movement of the wire within the breast. The wire is contained within a needle which is inserted into the breast under local anaesthetic, using either X-ray or ultrasound guidance.
Slide 54-

Preoperative localisation of Non palpable lesions When the tip of the needle has been shown to be satisfactorily positioned within 10 mm of the lesion, the needle sheath is withdrawn leaving the wire in situ. Check craniocaudal and lateral views are obtained to show the final position of the wire in relation to the lesion. Peroperative specimen radiography is mandatory to ensure that the excised breast tissue contains the mammographic abnormality.
Slide 55-

ppt slide no 55 content not found
Slide 56-

DIGITAL TOMOSYNTHESIS
Slide 57-

ppt slide no 57 content not found
Slide 58-

ppt slide no 58 content not found
Slide 59-

ppt slide no 59 content not found
Slide 60-

ppt slide no 60 content not found
Slide 61-

ppt slide no 61 content not found
Slide 62-

ppt slide no 62 content not found
Slide 63-

ppt slide no 63 content not found
Slide 64-

ppt slide no 64 content not found
Slide 65-

ppt slide no 65 content not found
Slide 66-

US Elastography Ultrasound (US) elastography is an imaging technique that can visualize tissue elasticity (stiffness) in vivo. Two types of Elastography Strain Elastography (SE) Shear wave elastography (SWE)
Slide 67-

US elastography The most common type of strain elastography (SE) displays relative tissue displacement under compression, whereas SWE displays an image of the shear-wave speed using acoustic radiation force excitation.
Slide 68-

Interpretation of US Elastography Strain Elastography When the breast tissue is pressed by the transducer, a hard lesion undergoes less strain than does the surrounding soft background. The relative strain in the tissue is displayed in a black- and-white (bright, soft; dark, hard) or color-coded (red, soft; blue, hard) image. In SE, the lesion size or area on the elastogram is compared to the corresponding lesion on the B-mode US image, as malignant lesions appear larger on elastograms than on B-mode US images.
Slide 69-

Strain Elastography Itoh et al. proposed the 5-point scale elasticity score indicating an increasing probability of malignancy that is most commonly used for SE. A cut-off point between the elasticity scores of 3 and 4 was initially suggested to differentiate benign from malignant breast lesions. However, a cut-off point between the elasticity scores of 1 and 2 or 2 and 3 was used in several studies and achieved better diagnostic performance with less interobserver variability.
Slide 70-

Strain Elastography Recently, elasticity scores are classified into three categories: score of 1 (even strain across the entire lesion) as negative, scores of 2 and 3 (uneven strain in the lesion) as equivocal, and scores of 4 and 5 (no strain across the entire lesion) as positive results. A specific bull’s eye artifact on black-and-white images or an aliasing artifact that appears as a blue-green-red (BGR) pattern on colorcoded images can be observed in simple cysts.
Slide 71-

ppt slide no 71 content not found
Slide 72-

Shear-Wave Elastography Using SWE, transversely oriented shear waves are generated by acoustic radiation force, and these waves propagate faster in hard tissue than soft tissue. A color-coded image displaying the shear wave velocity (m/sec) or elasticity (kilopascals, kPa) for each pixel in the region of interest (ROI) is acquired. Generally, a color scale ranging from 0 (dark blue, soft) to +180 kPa (red, hard) is used for breast lesions. A variety of qualitative and quantitative parameters of SWE have been studied so far , and the most useful SWE feature is the color assessment of the maximum elasticity, which is correlated with the maximum elasticity value (kPa).
Slide 73-

Shear-Wave Elastography The positive predictive value for malignancy increases with increasing elasticity, from 0.4% for dark blue to 81.8% for red colors. The maximum elasticity colors on SWE can be classified into three categories: dark blue and light blue colors (representing soft elasticity) as negative, green and orange colors (intermediate elasticity) as equivocal, and red colors (hard elasticity) as positive. Signal-void areas that are not color-coded even in the penetration mode can appear in simple cysts or in very hard masses with dense collagen deposition, as shear waves cannot propagate through them.
Slide 74-

ppt slide no 74 content not found
Slide 75-

MRI of Breast
Slide 76-

Standards for the performance of breast MRI
Slide 77-

MRI of Breast The fat have faster relaxation times (greater interaction between molecules), so their T1 signal is shorter than pure water; thus, fat has the shortest T1 relaxation time. By convention, tissues with short T1 are presented as bright signals on T1 images.
Slide 78-

MRI of Breast Signals from Water: tissues with a long T2 are presented as bright signals on T2-weighted images. Thus, cysts (that contain fluid) with long T1 are dark on T1-weighted images and those with long T2 are bright on T2-weighted images.
Slide 79-

On MRI this cyst had a characteristically low signal intensity (black) on this T1-weighted image (A) and a high signal intensity (white) on the T2-weighted image (B).
Slide 80-

FAT Suppression : Because of the high signal intensity of fat on T1 images, it is often difficult to appreciate enhancing lesions on gradient-echo images from the high signal produced by fat on T1- weighted images. Consequently, methods have been devised that eliminate the high signal from fat so that the tissues that enhance following contrast administration are more easily appreciated .
Slide 81-

Fat suppression makes enhancing lesions easier to appreciate. Fat has low signal intensity on this fat-saturated T1-weighted image (A) prior to the IV administration of contrast. The cancer in the left breast is more evident on the first fat-saturated set of images following contrast injection
Slide 82-

Breast MRI indications 1-Preoperative evaluation of patients with newly diagnosed breast cancer: when combined with mammography and clinical breast exam, has been shown to provide sensitivity of 99% for the preoperative assessment of the local extent of disease in patients with newly diagnosed breast cancer.
Slide 83-

The purpose of MRI is to detect the presence of multifocal and multicentric disease as well as to detect bulky residual disease at the lumpectomy site in order to allow directed re- excision. malignancies may enhance at much more rapid initial rates than benign lesions.
Slide 84-

Breast cancer staging is based on the extent of local-regional disease in the breast and axilla, which has predictive value regarding the patient's prognosis and dictates treatment options. MRI sensitivity rates for the detection of invasive breast cancer are estimated to be as high as 95-100%. •
Slide 85-

Breast cancers are usually irregular in shape and heterogeneous in their enhancement on MRI.
Slide 86-

2- evaluation of breast cancer patients treated with neoadjuvant chemotherapy. MRI has been used to monitor treatment response to neoadjuvant chemotherapy in patients with locally advanced cancer. Change in tumor vascularity/enhancement appear to explain changes in functional dynamic contrast assessment and can be seen after only one cycle of chemotherapy.
Slide 87-

Neoadjuvant chemotherapy. Sagittal post contrast fa suppressed T1W image prior to chemotherapy show an enhancing mass correlating to a biopsy-proven invasive ductal carcinoma (A). Following chemotherapy, a comparable image shows only a small area of residual enhancement (B)
Slide 88-

3- evaluation of patients with metastatic axillary lymphadenopathy and an unknown primary malignancy. 4- evaluation of breast cancer patients with positive surgical margins following breast conservation therapy. MRI can be useful in determining the extent of residual disease when margins are positive and the mammogram is not helpful.
Slide 89-

Postsurgical MRI can demonstrate residual malignant disease. The postoperative MRI shows the seroma cavity on both the T2 images
Slide 90-

(A) Retropectoral and (B) retroglandular placement of implants on MRI. Sagittal T1-weighted images of two different patients with silicone implants. 5- determination of silicone breast implant integrity.
Slide 91-

6-breast cancer screening in high risk women. 7- use of breast MRI as a problem-solving tool for equivocal mammographic findings and for 3-dimensional localization of a lesion seen.
Slide 92-

8- Evaluation of occult breast cancer In patients with an occult primary presenting with axillary lymphadenopathy or Paget's disease, MRI has been shown to identify the primary in many patients, thus allowing for conservative surgery rather than mastectomy.
Slide 93-

Detection of occult malignancy. This patient had a positive axillary lymph node with a negative clinical examination
Slide 94-

9-small breast (MRI) is well suited to the investigation of breast cancer by virtue of its noninvasive nature and its multiplanar imaging abilities. 10-Post surgical scar vs. recurrent tumor In cases where mammography and ultrasound are inconclusive in patient suspected of recurrent disease, MRI can be helpful. Breast tissue can show enhancement for up to 18 months following radiation therapy.
Slide 95-

Invasive breast cancer visible on T1- weighted image because of the surrounding fat.
Slide 96-

Cysts are bright on T2. In this mammogram of the right breast (A), the dense tissues obscure the cysts that are easily seen on the T2-weighted MRI examination (B).
Slide 97-

Blood in the ducts can be bright on T1. This patient had a bloody nipple discharge on the right The blood in the duct is bright on the precontrast T1 image.
Slide 98-

11-Breast MRI has consistently been found to detect additional unsuspected malignancy within the ipsilateral breast(in 10% to 27% of patients).
Slide 99-

12-Pectoral muscle tumor invasion. .
Slide 100-

C. Inappropriate Use of Breast MRI 1. Screening of general population At present there is no data to support the use of MRI as a screening tool. To date, there are no studies demonstrating decreased mortality by the use of MRI. Not all cancers seen on mammography can be identified in MRI.
Slide 101-

2. Differentiation of benign & malignant lesions Because of an overlap between the enhancement and morphological characteristics of benign and malignant lesions, MRI cannot be used as a substitute for biopsy.
Slide 102-

Scinti Mammography
Slide 103-

Indications for scinti-mammography Indeterminate lesions Dense Breasts Implants Post Sx /RT Bone scan Sentinel node biopsy
Slide 104-

Indication for molecular imaging Staging of patient with distant mets Loco regional extent Response to therapy Restaging of patient with loco regional recurrence/mets Monitoring response to therapy Lymph node and mets Dense breast Implants Localize Primary in presence of mets Bone metastasis
Slide 105-

ppt slide no 105 content not found
Slide 106-

PET Imaging
Slide 107-

CAD Computer-aided detection (CAD) is a computer software system that is designed to aid the film reader by placing prompts over areas of concern, and to try to reduce observational oversights. CAD systems are highly sensitive for detecting cancers on screening mammograms. CAD software will correctly prompt around 90% of all cancers, with 86–88% of all masses and 98% of microcalcifications correctly marked. Specificity is much more of a problem with a high rate of false-positive prompts. The number of false prompts will vary according to the level of sensitivity at which the system is set; typically there are between two and four false prompts per study
Slide 108-

CAD
Slide 109-

Thank you