MR imaging of extracapsular silicone from breast implants: Diagnostic pitfalls
MR imaging of extracapsular silicone from breast implants: Diagnostic pitfalls
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DOI：
10.2214/ajr.178.2.1780465
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发表时间：
2002-02-01
影响因子：
5
通讯作者：
Brown, SL
中科院分区：
文献类型：
--
作者：
Berg, WA;Nguyen, TK;Brown, SL
目标。我们试图找出在MR成像中识别囊外硅胶的陷阱。材料和方法。三名经验丰富的观察员回顾了359名女性的磁共振图像，这些女性目前（n = 320），以前（n = 15），或者目前和以前（n = 24）植入硅胶。在1.5 t磁铁上的专用相控阵乳房线圈中获得了水抑制的轴向和矢状快速自旋回波t2加权图像、水抑制的轴向反转恢复t2加权图像和硅酮抑制的轴向t2加权图像。当只有一个观察者看到囊外硅胶时，再次检查图像，并记录不一致的原因。目前使用硅胶植入物的265名女性（77%）和687名植入物中的378名（55%）发生破裂。观察人员一致认为，目前使用硅胶植入物的687个乳房中有85个（12%）出现囊外硅胶，其中81个（95%）在磁共振成像上显示明确的破裂证据。一名观察员报告了另外79个乳房的囊外硅胶。79例不一致中有33例（42%）是由于囊体弱化或破裂导致的轮廓畸形混淆。另外20例（25%）的79例不一致归因于快速自旋回波t2加权图像上囊外硅胶的不明显性以及间歇观察者未能检查反转恢复图像。发现的微妙性（n = 17, 22%）和技术问题（n = 9, 11%）与胸腔积液或囊肿和鬼影的水抑制失败有关。囊外破裂通常表现为乳房硅酮的局部扩散，在快速自旋回波t2加权图像上不能很好地描述。通常需要水抑制反演恢复t2加权图像来识别囊外硅胶。纤维囊内的隆起与通过囊的疝的区别仍然存在问题。
OBJECTIVE. We sought to identify pitfalls in recognition of extracapsular silicone on MR imaging.MATERIALS AND METHODS. Three experienced observers reviewed MR images from 3,59 women with current (n = 320), prior (n = 15), or both current and prior (n = 24) silicone gel implants. Axial and sagittal fast spin-echo T2-weighted images with water suppression, axial inversion-recovery T2-weighted images with water suppression, and axial T2-weighted images with silicone suppression were obtained in a dedicated phased array breast coil on a 1.5-T magnet. Images were reviewed again when only one observer saw extracapsular silicone, and reasons for disagreement were recorded.RESULTS. Rupture was identified in 265 women (77%) with current silicone implants and 378 (55%) of 687 implants. Observers agreed in describing extracapsular silicone in 85 (12%) of 687 breasts with current silicone gel implants, of which 81 (95%) showed definite evidence of rupture on MR imaging. One observer reported extracapsular silicone in another 79 breasts. Confusion over contour deformity due to weakening versus breach of the capsule accounted for 33 (42%) of 79 disagreements. Another 20 (25%) of the 79 disagreements were attributed to poor conspicuity of extracapsular silicone on fast spin-echo T2-weighted images combined with intermittent observer failure to review inversion-recovery images. Subtlety of findings (n = 17, 22%) and technical issues (n = 9, 11%) with failed water suppression of pleural effusion or cysts and ghosting artifacts accounted for remaining disagreements.CONCLUSION. Extracapsular rupture is usually manifest as local spread of silicone in the breast and is not well-depicted on fast spin-echo T2-weighted images. Water-suppressed inversion-recovery T2-weighted images are often needed to identify extracapsular silicone. Distinction of the bulge in the fibrous capsule from herniation through the capsule remains problematic.