#MyRadGirlfriend No. 97: Your worst day

Ryan McBeth
Nov 7, 2019
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(A) Ultrafast MR image obtained 14 seconds after aortic enhancement shows 0.4-cm focus (arrow) in the left breast at 3-o’clock position, 4.5 cm from index cancer (not shown). (B) Ultrafast MR image obtained 23 seconds after aortic enhancement shows wash-in (arrow) of background parenchymal enhancement (BPE). (C) and (D) On first standard postcontrast subtraction MR images, focus (arrow, C) and BPE (arrow, D) are indistinguishable. MRI-guided biopsy of focus yielded grade 2 invasive lobular carcinoma. Image courtesy of the ARRS.
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Schematic diagrams and representative images of different distribution patterns of region lymph nodes detected at CT. (A) Vascular distribution pattern: All regional lymph nodes detected at CT have regular borders and are distributed along the vessels (arrowheads). (B-E) Coronal CT images in a (B) 34-year-old woman, (C) 51-year-old man, (D) 37-year-old man, and (E) 40-year-old man with microsatellite instability-high (MSI-H) colon cancer show multiple clear lymph nodes distributed along the supplying arteries or draining veins (arrowheads). (F) Jammed cluster pattern: At least three lymph nodes with blurred margins and clustered (circle). (G-I) Coronal CT images in a (G) 29-year-old man, (H) 35-year-old man, and (I) 67-year-old man and (J) axial CT image in a 43-year-old man with MSI-H colon cancer show several lymph nodes with blurred margins and clustered (circle). Movies 1-4 provide more details. (K) Fused pattern: Several poorly defined lymph nodes clustered and fused together (arrow). (L-O) Coronal CT images in a (L) 63-year-old woman, (M) 59-year-old man, (N) 49-year-old woman, and (O) 73-year-old man with MSI-H colon cancers show several lymph nodes fused (arrow). Image courtesy of Radiology.
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