Metastatic breast cancer

Clinical History:
This is a 59-year-old female with a history of infiltrating ductal breast cancer, s/p partial mastectomy in 2007 and radiotherapy in 2008.

Diagnosis:
Metastatic breast cancer

MR Technique:
3.0 T scanner (Siemens Verio) using a body matrix coil anteriorly and a spinal coil posteriorly. Image 1: axial T2-weighted HASTE image with fat saturation and breath hold technique (TR/TE 1800/96 ms, scan time 53 sec, slice thickness 5 mm); Image 2: axial T1 VIBE (TR/TE 3.9/1.3 ms, scan time 13 sec, slice thickness 4 mm) without contrast; Image 3: axial T1 VIBE (TR/TE 3.9/1/3, scan time 13 sec, slice thickness 4 mm) after injection of 0.1 mmol/kg of gadolinium chelate; Image 4: DWI (TR/TE 5.5/2.5 ms, scan time 4 min 17 sec, slice thickness 3 mm).

Imaging Findings:
Multiple enahncing lesions show intermediate signal intensity on T2 (image 1) and some with low singal intensity on T1 (Image 2). There is isoenhancement on portal and venous phases (Image 3); there is restricted diffusion noted on DWI (Image 4) without corresponding low signal on the ADC map (not shown).

Additional findings not shown on the images include lymphadenopathy (enhancing 1.8 cm, adjacent to the second portion of the duodenum as well as 1.4 cm, in the gastrohepatic region) which illustrated restricted diffusion. Multiple foci of increased signal intensity were seen in the visualized lumbar vertebral bodies and in a right lower rib on T2/DWI.