In January 2002, anticipating a revolution in breast
imaging, Rebecca G. Stough, M.D. launched Oklahoma’s first comprehensive breast MRI
program that incorporated MRI into routine clinical care.
After gaining her initial experience with three hundred patients undergoing breast MRI using a “breast coil” adapter on a hospital body scanner, Dr. Stough switched to the Aurora breast-dedicated MRI located at Mercy Women’s Center in March 2003. Since that time, her experience in interpreting over one thousand breast MRIs per year has brought her into the limelight with this revolutionary technology. Dr. Stough now serves on the Medical Advisory Board of Aurora Imaging, Inc. where president and CEO Olivia Cheng, has stated, “Dr. Stough is one of the most experienced doctors in the world reading bilateral RODEO images…your team is truly outstanding and it’s our honor to partner with you.” Dr. Stough has also been a pioneer in the development of MRI-biopsy techniques, and she spends a good deal of time in worldwide travels, educating radiologists about breast MRI and MRI-guided biopsy techniques (see our Newsletter Section). Dr. Stough serves as Clinical Director of Breast MRI of Oklahoma, LLC., while Dr. Carol O’Dell serves as Assistant Clinical Director, also having interpreted thousands of dedicated breast MRIs.
Dr. Stough (left) joined RODEO MRI pioneer,
Dr. Steven Harms (right) in a trip to Taiwan, training radiologists in the interpretation of breast MRI |
Dr. Carol O’Dell is a breast-dedicated radiologist who serves as Assistant Clinical Director of Breast MRI of Oklahoma |
Newly diagnosed breast cancer – mapping tumor size and extent to assist with lumpectomy vs. mastectomy decisions; checking for other areas of cancer in the same breast; screening the opposite breast for cancer not appreciated on conventional imaging
Diagnostic problems not settled by conventional imaging (multiple or inconclusive findings)
Judging the response to neoadjuvant chemotherapy
Distinguishing scar from recurrent cancer in lumpectomy patients
Searching for a primary cancer when axillary nodes are found to harbor malignancy
Evaluating for ruptured breast implants
Difficult diagnostic problems in patients with breast implants
Pre-operative study to rule out cancer prior to implants or reduction surgery
High Risk Screening (esp. in patients with dense tissue on mammography)
FOR FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT BREAST MRI CLICK HERE.
The images below are somewhat limited for online viewing in that actual interpretations are performed on the computer by the radiologist who “pages through” hundreds of images, in multiple directions, or by creating 3-D “holograms.” In addition, the images below are from the “early” days of breast MRI, pre-RODEO™. For a peek at the remarkable 3-D images we see today with spiralRODEO™,
CLICK HERE.
Fig 1
Normal Breast MRI
Breast MRI includes many variations of the procured images. In this “MIP” version, the thin slices are re-assembled, creating a 3-D image on the computer that can be rotated in any direction. Only the gadolinium contrast is seen, so any worrisome “areas of enhancement” can be viewed from all angles. The branching white lines in this study (arrow) represent normal blood vessels. This negative study is a powerful statement that no cancer is present in this breast.
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Fig 2
Small invasive cancer
In this subtraction view, only a thin slice of gadolinium contrast is seen, revealing a sub-centimeter invasive ductal carcinoma (arrow). A tumor this small will be invisible on mammography if it is surrounded by dense breast tissue. The advantage to finding cancer smaller than 1.0 cm is a cure rate in excess of 90% if lymph nodes are clear, along with infrequent use of chemotherapy.
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Fig 3 (left)
Ductal carcinoma in Situ (DCIS)
While often called “early” breast cancer, DCIS can still spread throughout the ductal system and be more difficult to eradicate from the breast than many invasive cancers. Calcium is best detected on mammography, and it often leads to DCIS, but the extent of disease is frequently underestimated. In addition, many DCIS lesions do not develop calcium at all. Once again, Breast MRI is proving to be a very helpful adjunct in the detection of DCIS. In this patient’s breast, the DCIS forms both patchy and linear enhancements, and the problem proved to be much more extensive than believed from mammography alone.
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Fig 4a (left) and 4b (right)
Axillary Adenopathy with Unknown Primary
This patient presented with an enlarged lymph node in her axilla (left: arrow) that proved to harbor metastatic cancer cells. While breast is the most likely site of origin, it is not always true, and this patient’s mammograms were normal. In years past, women presenting with malignant axillary nodes would undergo “blind” mastectomy, and it was not unusual for the breast to be normal on pathology exam (or, to find a small cancer that could have been handled easily with lumpectomy). Today, with breast MRI, one can see how clearly the subtraction view (right) shows a multifocal cancer (arrows) that was invisible on routine imaging studies.
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(left to right) Fig 5a, Fig 5b, and Fig 5c
Extent of Cancer Grossly Underestimated by Mammography and Ultrasound.
Mammograms were low density in this patient, so when “invasive ductal carcinoma” was diagnosed from a solitary mass lesion, mammograms were felt to have accurately mapped the tumor pre-operatively. Ultrasound further confirmed a small, solitary tumor, so lumpectomy was advised and performed on the left breast. However, the surgeon was unable to obtain clear margins around the tumor after several attempts, so the procedure was ended, and breast MRI performed. In Figure 5a, one can see the large lumpectomy cavity (small arrows outline the bright fluid in the cavity), while an extensive area of residual cancer remains (large arrow). This residual cancer is best seen in the subtraction view (Figure 5b) as it extends throughout a large area (arrow) of the breast. However, the opposite breast (Figure 5c) had several areas of suspicious enhancement as well (arrow shows one example in the upper outer quadrant). Final diagnosis after bilateral mastectomy: extensive infiltrating lobular carcinoma, involving multiple quadrants in both breasts.
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