ARRS Case of the Week

BREAST IMAGING: Postsurgical Breast

Case Author: Tanya W. Stephens, MD, The University of Texas M. D. Anderson Cancer Center


74-year-old woman with multiple myeloma and bilateral implants with 3 months of enlargement of the left breast; an imaging evaluation and complete bone survey have been performed, and the next step must be determined.

Clinical Case Based Review of Breast Imaging

Imaging Findings

Selected image of the chest from a complete bone survey shows bilateral healed lower rib fractures (arrows).

Next Steps

Mammography followed by breast MRI

Teaching Points

CT of the breast can yield superior soft-tissue images but has limitations with respect to spatial resolution and dose. Although calcifications are detectable with breast CT, the morphologic features of calcifications are better evaluated with mammography.

Although breast-specific gamma imaging has been found to be sensitive in the detection of breast cancer, when breast enlargement may be due to intrinsic breast disease, breast implants, or a chest wall abnormality, imaging must depict the breast, breast implants, and musculoskeletal system (chest wall). MRI is better suited to this purpose.

Breast MRI is superior to breast ultrasound in the evaluation of the chest wall and breast implants.

The morphologic features of calcifications are better evaluated with mammography.

Suggested Readings

Kalender WA, Beister M, Boone JM, Kolditz D, Vollmar SV, Weigel MC. High-resolution spiral CT of the breast at very low dose: concept and feasibility considerations. Eur Radiol 2012; 22:1–8

Tadwalkar RV, Rapelyea JA, Torrente J, et al. Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade. Br J Radiol 2011 Jun 28 [Epub ahead of print]

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