Breast Imaging
Basic Course For Medical College Student
WANG Deng-bin
MD,Ph.D
Dept,of Radiology,RuiJin
Hospital SSMU,P.R.China
Introduction
“Breast cancer is one of the best studied
human tumors,but it remains poorly
understood”
,As in all medical endeavors,the practitioner
should,whenever possible,use the results of
scientific studies to guide clinical decision”
And the imaging modalities implemented
in clinical practice for breast care must
be served as the tools for detection and
characterization of breast lesions,As we
expect,they are very important for
diagnosis and treatment,
Imaging Modalities
1.5T MRI
GE signa gemsow
0.5T MRI
GE signa
Sys#MRS
Shanghai 2nd Medical University
Rui Jin Hospital
X-ray Examination Mammograpy
?X-ray radiography (molybdenum X rays,
rhodium X rays):MLO,CC,etc,
?Galactography --demonstrates the ducts
and ductule or their abnormalities,
galactography
USG
?Ultrasonography (ultrasound)
?B-mode US
?Doppler US
CT
?Computed tomography
?plain scan,
?enhanced scan (iodine)
MRI
?Magnetic Resonance Imaging
?high resolution for soft tissue
?different tissue,different signal
?enhanced scan
The others
?Infrared thermal imaging
?Computer diaphanography imaging,etc,
Imaging-Guided Percutaneous Biopsy
supply specimens for pathologic examination
? Fine needle aspiration biopsy (FNAB)
? Needle core biopsy (NCB)
Interventional Therapy
? Laser
? Radiofrequency
? Embolization
? and so on
Accessory Breast Tissue
?The most common site is axilla
Basic Imaging Signs of Breast Lesion
?Mass/Lump
?Calcification
?Thickening and retraction of regional skin
?Retraction of nipple
?Enlargement or abnormality of blood vessels
?Lymph nodes
?Enhanced manifestations
Mass/Lump
shape,round,oval,regular/irregular
margin,clear or ambiguous,spiculation or smooth
density or signal intensity,high/low/intermediate
with or without calcification
site,upper-outer quadrant breast,upper-inner quadrant
breast,lower outer quadrant breast,lower-inner quadrant
breast,nipple,central portion breast,axillary tail breast,
Number,solitary or multiple
Calcification
Size,large or micro
Shape,ring-like,nodular or salt-like,branching
Distribution,scattered or clustered with or
without mass
benign / malignant
Thickening and Retraction of
Regional Skin
? Frequently found in malignant tumors
? Sometimes due to postsurgical scars,
Retraction of Nipple
?Congenital-dysplasia
?Acquired-malignant tumor
Enlargement or Abnormality
of Blood Vessel
? Mostly in malignant tumor due to
increase of blood supply
Enlargement of Lymph Nodes
?Axillary or intramammary lymph nodes
Administration of Contrast
Agents for Breast Lesions
?Implication of the lesion’s hemodynamics
?washout type--malignant
?linear--benign
?plateau--malignant/benign
Common Diseases in Breast
? Fibroadenoma
? Cyst
? Lobular hyperplasia
? Cancer
Fibroadenoma overview
Frequency,most common tumor of breast (benign)
Age,below 30 yrs
Distribution,unilateral or bilateral
Source tissue,connective tissue and glandular tissue
Site,upper-outer quadrant
Size,< 5cm
Surface,smooth,movable
Imaging Findings of Fibroadenoma
? X-ray
? CT
? MRI
X-ray Findings
?Round,lobular or oval mass or
nodule,smooth nodule in high density with
thin ring/ halo in low density
?Compression of surrounding tissue
?Large calcification:always dominated at the
center of tumor
CT Findings
?Round smooth mass/nodule
?Value of CT similar to normal glandular
tissue
?Calcification
?Intermediate enhancement,linear type or
plateau,relatively long duration of
enhancement
Breast Cancer overview
? most frequent malignancy in women
?1% in adult women in China
?34.4/100 thousand in 1989
?39.7/100 thousand in 1993
?46/100 thousand in 1997
?52.98/100 thousand in women of Shanghai in 2001
?over 100/100 thousand in women in Europe and USA
Breast Cancer overview
Age,40-60yrs,in China 1/5 are <35yrs
Gender,female (male)
Clinical
?mass,unmovable mass,
?skin,orange-peel-like,retraction
?aching
?retraction/discharge of nipple
?enlargement of blood vessels
?stiffness of breast
?lymph nodes
Breast Cancer overview
?Pathology
Invasive ductal carcinoma 65-80%
Intraductal carcinoma 15%
Lobular carcinoma(invasive/in situ) 5%
Special types 10%
X-ray Findings of Breast Cancer(1)
?Irregular/regular mass
?Ambiguous border
?Spiculations
?Heterogeneous density,mostly higher than
the Surrounding tissue
?Site,over 50% at upper-outer quadrant
X-ray findings of breast cancer(2)
? Calcification,clustered salt-like
microcalcification in 1/3 cases inside/outside the
mass,sometimes only the microcalcifications
observed
? Retraction of nipple
? Thickening of skin
? Abnormal blood vessel
? Large patchy region in high density
CT Findings of Breast Cancer(1)
? Mass,irregular/ill-shaped,coarse margin,
spiculation,CT value,25-56HU,higher than
the normal breast,necrosis at the center of
the large mass(mostly >= 5cm)
? Skin,nipple
? Infiltration into the pectoralis major muscle
CT Findings of Breast Cancer(2)
?Occupying of retromammary space
?Enlargement of lymph nodes,axillary/retromammary
?Administration of contrast agents
?quick enhancement (wash in) at early phase
?the peak of enhancement occur within 50s ~1min
?quick washout
?time-signal intensity curve—— washout type
MRI Findings of Breast Cancer
? Signal intensity:T1WI SE,low;T2WI
FSE,low,intermediate,inhomogeneous;STIR,
intermediate
? Spiculation,irregular mass (lobular)
? Enhancement,time-signal intensity curve
Comparison of Different Imaging
Modalities for Detection and
Characterization of Breast Cancer
?Molybdenum X-ray radiography,
most important,widest used,most useful— not
very sensitive to the small lesion at very early
stage in dense breast;but digital mammography
can solve the problem to great extent
USG
? Cystic or solid
? Low spatial resolution
? Limited ability to Differentiate
benign/malignant
CT
? Wide coverage for viewing,sensitive to cystic
change,hemorrhage and calcification
? Very useful for detection and characterization
of masses,especially in the enhanced scan,
but can’t definitely view the microcalcification
? Much more radiation,expensive
MRI
? High soft resolution
? Better differentiation for benign/malignant
? Wider coverage
? Without radiation
? High cost
? Not sensitive to calcification
CT C- CT C+
MR C+
Combination of Varying
Imaging Modalities
? Acquire the richest information
? Appropriateness in application
? Cost-effectiveness
? Best diagnosis,timely correct therapy,
better health
? To the women of the world,may
breast cancer soon be eliminated
as a source of dread and death
? To breast cancer researchers and
breast health caregivers,may our
efforts soon be unnecessary
Basic Course For Medical College Student
WANG Deng-bin
MD,Ph.D
Dept,of Radiology,RuiJin
Hospital SSMU,P.R.China
Introduction
“Breast cancer is one of the best studied
human tumors,but it remains poorly
understood”
,As in all medical endeavors,the practitioner
should,whenever possible,use the results of
scientific studies to guide clinical decision”
And the imaging modalities implemented
in clinical practice for breast care must
be served as the tools for detection and
characterization of breast lesions,As we
expect,they are very important for
diagnosis and treatment,
Imaging Modalities
1.5T MRI
GE signa gemsow
0.5T MRI
GE signa
Sys#MRS
Shanghai 2nd Medical University
Rui Jin Hospital
X-ray Examination Mammograpy
?X-ray radiography (molybdenum X rays,
rhodium X rays):MLO,CC,etc,
?Galactography --demonstrates the ducts
and ductule or their abnormalities,
galactography
USG
?Ultrasonography (ultrasound)
?B-mode US
?Doppler US
CT
?Computed tomography
?plain scan,
?enhanced scan (iodine)
MRI
?Magnetic Resonance Imaging
?high resolution for soft tissue
?different tissue,different signal
?enhanced scan
The others
?Infrared thermal imaging
?Computer diaphanography imaging,etc,
Imaging-Guided Percutaneous Biopsy
supply specimens for pathologic examination
? Fine needle aspiration biopsy (FNAB)
? Needle core biopsy (NCB)
Interventional Therapy
? Laser
? Radiofrequency
? Embolization
? and so on
Accessory Breast Tissue
?The most common site is axilla
Basic Imaging Signs of Breast Lesion
?Mass/Lump
?Calcification
?Thickening and retraction of regional skin
?Retraction of nipple
?Enlargement or abnormality of blood vessels
?Lymph nodes
?Enhanced manifestations
Mass/Lump
shape,round,oval,regular/irregular
margin,clear or ambiguous,spiculation or smooth
density or signal intensity,high/low/intermediate
with or without calcification
site,upper-outer quadrant breast,upper-inner quadrant
breast,lower outer quadrant breast,lower-inner quadrant
breast,nipple,central portion breast,axillary tail breast,
Number,solitary or multiple
Calcification
Size,large or micro
Shape,ring-like,nodular or salt-like,branching
Distribution,scattered or clustered with or
without mass
benign / malignant
Thickening and Retraction of
Regional Skin
? Frequently found in malignant tumors
? Sometimes due to postsurgical scars,
Retraction of Nipple
?Congenital-dysplasia
?Acquired-malignant tumor
Enlargement or Abnormality
of Blood Vessel
? Mostly in malignant tumor due to
increase of blood supply
Enlargement of Lymph Nodes
?Axillary or intramammary lymph nodes
Administration of Contrast
Agents for Breast Lesions
?Implication of the lesion’s hemodynamics
?washout type--malignant
?linear--benign
?plateau--malignant/benign
Common Diseases in Breast
? Fibroadenoma
? Cyst
? Lobular hyperplasia
? Cancer
Fibroadenoma overview
Frequency,most common tumor of breast (benign)
Age,below 30 yrs
Distribution,unilateral or bilateral
Source tissue,connective tissue and glandular tissue
Site,upper-outer quadrant
Size,< 5cm
Surface,smooth,movable
Imaging Findings of Fibroadenoma
? X-ray
? CT
? MRI
X-ray Findings
?Round,lobular or oval mass or
nodule,smooth nodule in high density with
thin ring/ halo in low density
?Compression of surrounding tissue
?Large calcification:always dominated at the
center of tumor
CT Findings
?Round smooth mass/nodule
?Value of CT similar to normal glandular
tissue
?Calcification
?Intermediate enhancement,linear type or
plateau,relatively long duration of
enhancement
Breast Cancer overview
? most frequent malignancy in women
?1% in adult women in China
?34.4/100 thousand in 1989
?39.7/100 thousand in 1993
?46/100 thousand in 1997
?52.98/100 thousand in women of Shanghai in 2001
?over 100/100 thousand in women in Europe and USA
Breast Cancer overview
Age,40-60yrs,in China 1/5 are <35yrs
Gender,female (male)
Clinical
?mass,unmovable mass,
?skin,orange-peel-like,retraction
?aching
?retraction/discharge of nipple
?enlargement of blood vessels
?stiffness of breast
?lymph nodes
Breast Cancer overview
?Pathology
Invasive ductal carcinoma 65-80%
Intraductal carcinoma 15%
Lobular carcinoma(invasive/in situ) 5%
Special types 10%
X-ray Findings of Breast Cancer(1)
?Irregular/regular mass
?Ambiguous border
?Spiculations
?Heterogeneous density,mostly higher than
the Surrounding tissue
?Site,over 50% at upper-outer quadrant
X-ray findings of breast cancer(2)
? Calcification,clustered salt-like
microcalcification in 1/3 cases inside/outside the
mass,sometimes only the microcalcifications
observed
? Retraction of nipple
? Thickening of skin
? Abnormal blood vessel
? Large patchy region in high density
CT Findings of Breast Cancer(1)
? Mass,irregular/ill-shaped,coarse margin,
spiculation,CT value,25-56HU,higher than
the normal breast,necrosis at the center of
the large mass(mostly >= 5cm)
? Skin,nipple
? Infiltration into the pectoralis major muscle
CT Findings of Breast Cancer(2)
?Occupying of retromammary space
?Enlargement of lymph nodes,axillary/retromammary
?Administration of contrast agents
?quick enhancement (wash in) at early phase
?the peak of enhancement occur within 50s ~1min
?quick washout
?time-signal intensity curve—— washout type
MRI Findings of Breast Cancer
? Signal intensity:T1WI SE,low;T2WI
FSE,low,intermediate,inhomogeneous;STIR,
intermediate
? Spiculation,irregular mass (lobular)
? Enhancement,time-signal intensity curve
Comparison of Different Imaging
Modalities for Detection and
Characterization of Breast Cancer
?Molybdenum X-ray radiography,
most important,widest used,most useful— not
very sensitive to the small lesion at very early
stage in dense breast;but digital mammography
can solve the problem to great extent
USG
? Cystic or solid
? Low spatial resolution
? Limited ability to Differentiate
benign/malignant
CT
? Wide coverage for viewing,sensitive to cystic
change,hemorrhage and calcification
? Very useful for detection and characterization
of masses,especially in the enhanced scan,
but can’t definitely view the microcalcification
? Much more radiation,expensive
MRI
? High soft resolution
? Better differentiation for benign/malignant
? Wider coverage
? Without radiation
? High cost
? Not sensitive to calcification
CT C- CT C+
MR C+
Combination of Varying
Imaging Modalities
? Acquire the richest information
? Appropriateness in application
? Cost-effectiveness
? Best diagnosis,timely correct therapy,
better health
? To the women of the world,may
breast cancer soon be eliminated
as a source of dread and death
? To breast cancer researchers and
breast health caregivers,may our
efforts soon be unnecessary
