隆乳术后的MRI表现

目的分析隆乳术后MRI表现，探讨其临床价值。方法对63例隆乳术后患者行MR扫描，分别分析置入假体和注射假体的MRI表现。结果40例80只乳房行双侧聚丙烯酰胺水凝胶注入，其中50只乳腺假体呈不规则团块游离于腺体内、胸肌内、皮下等各处。7例行双侧白体脂肪注入，其中12只乳内见纤维脂肪团块，6只乳内见脂液平面，6只胸大肌内见脂肪。16例行双侧乳腺假体置入，其中2例行生理盐水假体置入，2只盐水假体破裂；14例行硅胶假体置入，其中4只假体囊外破裂，10只假体囊内破裂。结论MRI是评价乳腺假体置入术后情况的理想方法。     

Radiologic features of polyacrylamide gel mammoplasty

OBJECTIVE: The objective of our study was to describe the imaging features of polyacrylamide gel breast implants in women with and those without complications from mammoplasty. CONCLUSION: Although polyacrylamide gel implants may mimic conventional implants on both sonography and MRI in women who do not have complications from mammoplasty, polyacrylamide gel implants have some distinguishing features. The imaging appearance of polyacrylamide gel implants is related to the technique of injection and whether there are any associated complications. The implants are usually in a retroglandular location. Mammography, sonography, and MRI can be used to evaluate short-term complications, although MRI appears to be the most sensitive. Common short-term complications include extravasation of polyacrylamide gel and secondary infection, which may be related to lactation. The long-term complications of polyacrylamide gel mammoplasty are unknown. Knowledge of the appearances of polyacrylamide gel implants in women with and those without complications from mammoplasty is useful in the radiologic evaluation of such patients.     

MRI对隆乳手术术后患者的诊断价值

目的:探讨隆乳术后并发症MRI影像学特征及不同影像技术的诊断价值.方法:对32例63只隆乳术后出现症状的乳房行1.5T MRI平扫、3D FSE脂肪抑制水成像及VIBRANT动态增强扫描.结果:本组28例55只乳房行注射式水凝胶隆乳术,47只假体外漏,双乳不对称4例,1例2只为感染,1例1只为假体内出血,3例3只为腺体病变.1例行双侧乳房内自体脂肪注射术,乳房下部可见较多脂肪团块.3例行双侧乳房硅胶假体植入术,1例1只盐水假体变形,1例1只硅凝胶假体外漏.上述影像学表现均与取出术中结果相符.结论:MRI对诊断隆乳术后外漏并发症有着重要的价值,VIBRANT序列有助于诊断感染及腺体病变,3D FSE脂肪抑制水成像序列对水凝胶和硅胶盐水假体的整体显示有显著的优势.     

乳房假体破裂及注射水凝胶扩散的磁共振成像

目的 :探讨乳房假体破裂及注射聚丙烯酰胺水凝胶扩散的MRI表现及临床意义。方法 :对 18例隆乳术后患者行MR扫描 ,并与术中所见比较。对假体置入及注射聚丙烯酰胺水凝胶的MRI表现进行分类分析。结果 :正常单腔硅凝胶假体 9例 ;单腔硅凝胶假体纤维囊内破裂 13例 ,MRI示假体内有多发条丝状短T2 低信号 ,即“条丝征” ;单腔硅凝胶假体纤维囊外破裂 2例 ,MRI示乳房腺体内长T2 结节状内容物颗粒。正常聚丙烯酰胺水凝胶注射 3例 ,注射聚丙烯酰胺水凝胶扩散 9例 ,MRI示乳腺后间隙以外部位出现结节状长T1、长T2 信号。结论 :MRI可诊断乳房假体有无破裂或注射聚丙烯酰胺水凝胶有无扩散 ,可明确其漏出或扩散的范围 ,因此能为手术提供准确定位 ,为随访提供客观资料。     

Evaluation of MRI findings after polyacrylamide gel injection for breast augmentation

OBJECTIVE: Polyacrylamide gel injection mammoplasty has recently been used for breast augmentation. However, many complications have been reported including complications that in some patients resulted in the need for mastectomy. This article reviews the MRI appearances of various complications of polyacrylamide gel injection mammoplasty including breast asymmetry; intramammary or extramammary gel displacement, including intrathoracic extension; and glandular atrophy, inflammation, and infection resulting in mastectomy. CONCLUSION: Because poly acrylamide gel has a high water content, we found that sagittal and axial T2-weighted are the best sequences to use to detect complications.     

聚丙烯酰胺水凝胶注射隆乳术并发症的MRI诊断

目的 分析聚丙烯酰胺水凝胶注射隆乳术后并发症的Mill表现，并探讨其诊断价值。方法 对20例26个出现并发症的乳腺及1例健康志愿者乳腺的MPd资料进行回顾性分析。结果 感染及感染合并脓肿5例7个，表现为假体内团状长T1WI、长T2WI信号，T2WI信号较假体更高；无菌性炎症2例3个，假体包膜增厚，表现为稍长T1WI、等T2WI信号；硬结10例13个，表现为皮下、乳腺腺体内或胸大肌下的单个或数个固定的长T1WI、长T2WI信号；假体包膜破裂5例6个，表现为多发条块状、结节状长T1WI、长T2WI信号。诊断结果与临床和术后诊断结果符合。结论 聚丙烯酰胺水凝胶注射隆乳术后并发症的MRI表现具有一定特点，诊断价值大，宜作为首选方法。     

水凝胶注射隆乳术后的X线表现

目的探讨聚丙烯酰胺水凝胶（简称水凝胶）注射隆乳术后的临床及X线表现特点。方法67例均有明确水凝胶注射隆乳史，11例行手术取出水凝胶或乳房硬块，所有患者均经临床体检及乳腺X线摄片，对其结果进行回顾性分析。结果水凝胶注射隆乳术后多数乳房外观良好，质感异常及硬节形成为其主要后遗改变。X线片上水凝胶表现为高密度6例，稍高密度或等密度57例，低密度4例；水凝胶呈不规则团片影并多发类似肿块或结节影51例，呈均匀片状影16例；水凝胶与正常腺体分界不清46例，分界模糊11例，分界清晰10例；7例可见钙化灶显示。11例手术病理显示水凝胶周围纤维结缔组织增生及散在淋巴细胞浸润，其中1例合并纤维腺瘤，1例合并癌。结论乳腺X线片无法准确评估注射隆乳术后水凝胶的自身情况，同时水凝胶影响乳房肿块或结节病变的辨认及定性。     

X线及MRI对聚丙烯酰胺凝胶隆胸后乳腺病变诊断价值的评价与比较

目的对聚丙烯酰胺凝胶(PAG)注射式隆胸术后,出现并发症或合并乳腺其他病变的X线与MRI的诊断价值进行评估。方法回顾性分析26例PAG隆胸术后钼靶X线与MRI的影像表现。结果钼靶X线及MRI能显示充填物位置、形态,合并乳腺病变4例,X线全部漏诊,MRI能检出病灶。结论钼靶X线是PAG隆胸术后普查、随访的首选方法,但出现并发症或者合并乳腺病变时,MRI具有无法比拟的优越性,在临床诊断与治疗中发挥了重要作用。     

Imaging breasts with silicone implants

Over the last two decades, the use of breast implants both for breast augmentation and for breast reconstruction following mastectomy has increased substantially. It is estimated that around two million women have undergone breast augmentation, while hundreds of thousands have had breast reconstruction surgery. Different types of material have been used for breast implants, but silicone gel implants have been the dominating implant type. Many implants can lead to complications, such as hardening and rupture, and may therefore need in vivo evaluation by imaging, particularly if they lead to clinical symptoms. They can also pose problems in the assessment of surrounding breast tissue by conventional mammography. In this respect, imaging modalities such as ultrasound, computed tomography and magnetic resonance imaging offer greater possibilities to assess a failing implant, as well as surrounding breast tissue. Several factors, mainly of a psychological nature, lead to requests for breast implants. In this review article, only the imaging aspects of breasts with silicone gel implants will be dealt with. Each modality is concisely presented with its possibilities and limitations. Received: 5 February 1998; Revision received: 18 May 1998; Accepted: 25 May 1998     

聚丙烯酰胺水凝胶注射隆乳术后MRI表现与远期组织病理学变化

目的:探讨聚丙烯酰胺水凝胶(PAAG)注射隆乳后并发症、MRI表现、组织病理学变化与注入时间的关系.方法:选取PAAG隆乳术后要求取出假体的35例个体(70只乳房假体)为研究对象,注入时间1周～6年,按注入时间分为2年以内组(n=7),2～4年组(n=11),4～6年组(n=17) 3组.以术前乳房触诊结果记录各组临床...     

不同MRI序列检出聚丙烯酰胺水凝胶注射隆乳患者乳腺病变效能的比较研究

目的 探讨不同MRI序列对聚丙烯酰胺水凝胶（PAHG）注射隆乳后乳腺病变的检出效能。 方法 回顾性分析80例临床怀疑合并乳腺病变的注射隆乳患者的MRI影像资料,扫描序列包括T1加权像、T2加权像、短时间反转恢复（STIR）、弥散加权成像（DWI）、MR水成像（MRH）及肝脏容积超快速（LAVA）三维多期动态增强序列,分析各序列图像中病灶的信号特点、位置、形态、大小和数量,以及时间-信号强度曲线,分别计算不同序列对乳腺病变的总检出率和对乳腺癌的诊断准确率。各序列病灶的总检出率差异采用R×C交叉表卡方检验,组内两两比较采用卡方检验分析。 结果 160个乳腺中共检出86个病灶,其中乳腺癌病灶30个。T1加权像、T2加权像、STIR、DWI、MRH及LAVA增强序列对乳腺病灶的总检出率分别为32.56%（28/86）、61.11%（53/86）、63.88%（55/86）、41.66%（36/86）、89.53%（77/86）、100%（86/86）,其中乳腺癌病灶诊断准确率分别为33.33%（10/30）、66.67%（20/30）、66.67%（20/30）、46.67%（14/30）、100%（30/30）、100%（30/30）。对各序列乳腺病变的总检出率行R×C交叉表卡方检验:χ2=129.428,P < 0.05,差异有统计学意义;对各序列乳腺癌病灶诊断准确率行R×C交叉表卡方检验:χ2=51.843,P < 0.05,差异有统计学意义。对各序列乳腺病变总检出率和乳腺癌病灶诊断准确率行组内两两比较分析,除T1加权像与MRH、T2加权像与STIR对乳腺病变总检出率的差异无统计学意义外（χ2=1.593、0.100,P均>0.05）,其他均有统计学意义（χ2=6.729~87.509,P均 < 0.05）;而MRH与T1加权像、MRH与T2加权像、MRH与STIR、T2加权像与STIR,以及DWI与LAVA增强序列对乳腺癌诊断准确率的差异均无统计学意义（χ2=1.111、2.443、2.443、0.000、0.000,P均>0.05）,其他序列的差异有统计学意义（χ2=12.000~30.000,P均 < 0.05）。 结论 DWI和LAVA增强序列对PAHG注射隆乳后乳腺病变的总检出率最高;合理应用MRI序列,有利于提高乳腺癌病灶的诊断准确率。     

MRI of the breast: state of the art

Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5–12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prothesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication. Received 7 October 1997; Revision received 14 November 1997; Accepted 17 November 1997     

3.0T磁共振在乳腺检查中的初步应用

目的:探讨3.0T磁共振利用体部相控阵线圈进行乳腺检查的临床应用价值.方法:36例乳腺疾病患者中隆乳术后26例,乳腺癌6例,乳腺良性病变4例,均行常规MR T1WI、T2WI和压脂序列T2WI,17例行动态增强扫描,13例行扩散加权成像,并与术后病理结果进行对照分析.结果:36例乳腺疾病患者均能显示显示乳腺结构及邻近组织情况,图像清晰无变形.22例聚丙烯酰胺水凝胶注射隆乳术后患者,注入物于T1WI呈稍低信号、T2WI呈高信号,在脂肪抑制T2WI上显示最清晰,呈均匀高信号;4例角鲨烯注射液隆胸术后,注入物在T1WI和T2WI上呈小颗粒状脂肪信号影.6例乳腺癌于DWI上呈明显高信号,动态增强曲线呈早期信号快速上升,中晚期信号强度逐渐降低表现;4例发现腋窝淋巴结转移.4例乳腺良性病变,动态增强曲线呈逐渐上升改变.结论:3.0T磁共振结合体部相控阵线圈可显示隆胸材料的性质和分布,常规MRI扫描结合DWI和动态增强扫描对乳腺良恶性病变的鉴别诊断有重要临床价值.     

Breast augmentation and reconstructive surgery: MR imaging of implant rupture and malignancy

The purpose of this study was to assess the diagnostic accuracy of MRI in detecting prosthesis integrity and malignancy after breast augmentation and reconstruction. Forty-one implants in 25 patients were analyzed by MRI before surgical removal. Imaging results were compared with ex vivo findings. Magnetic resonance imaging of the breast was performed on a 1.5-T system using a dedicated surface breast coil. Axial and sagittal T2-weighted fast spin-echo as well as dynamic contrast-enhanced T1-weighted gradient-recalled-echo sequences were acquired. The linguine sign indicating collapse of the silicone shell or siliconomas indicating free silicone proved implant rupture, whereas early focal contrast enhancement of a lesion was suspicious for malignancy. The sensitivity for detection of implant rupture was 86.7% with a specificity of 88.5%. The positive and negative predictive values were 81.3 and 92.0%, respectively. The linguine sign as a predictor of intracapsular implant rupture had a sensitivity of 80% with a specificity of 96.2%. Magnetic resonance imaging revealed two lesions with suspicious contrast enhancement (one carcinoma, one extra-abdominal fibromatosis). Magnetic resonance imaging is a reliable and reproducible technique for diagnosing both implant rupture and malignant lesions in women after breast augmentation and reconstruction.     

Magnetic resonance imaging of the breast: current indications.

Breast magnetic resonance imaging (MRI) plays an increasing role in the management of selected breast cancer patients. MRI is recognized as the most sensitive modality for the detection of invasive breast cancer. Several valuable clinical applications of MRI have emerged for breast cancer detection and diagnosis from clinical investigations. Breast MRI is helpful for women diagnosed with breast cancer who contemplate breast conserving surgery; it provides valuable information on the extent of the disease. MRI can also help assess for residual invasive cancer in patients who have undergone lumpectomy with positive margins at pathology. It is very reliable in differentiating scar tissue from recurrence at the lumpectomy site. MRI is also reliable in finding a breast cancer in women with axillary nodal metastases and unknown primary tumour. MRI can help to monitor the response to chemotherapy. Breast MRI could be a better screening tool than mammography in women with very high risks of developing breast cancer, such as breast cancer gene carriers and patients treated with chest radiation. Other potential uses of MRI include evaluation of the integrity of silicone breast implants and evaluation of the parenchyma in women with silicone gel implants or free injection of silicone gel. However, like any other technique, breast MRI has some drawbacks, including low-to-moderate specificity, high costs, and variability in technique and interpretation. Radiologists must have a clear understanding of valid indications and selection criteria to use this technique appropriately.     

Siliconomas mimicking cancer

Introduction

Silicone breast implants are widely used for breast augmentation and breast reconstruction following mastectomy. Implant rupture has specific radiological signs. With the advent use of new imaging technique such as positron emission tomography (PET) computed tomography (CT) and magnetic resonance imaging (MRI) of the breast, these signs may simulate malignancy.

Patients and methods

We retrospectively reviewed four cases of patients with silicon breast implants who arrive to the mammography clinic for further evaluation of a suspected malignant process demonstrated on either PET CT or breast MRI.

Results

Two cases were of PET CT performed for routine oncology follow-up of breast cancer. On both, the PET CT demonstrated multiple-spread benign silicone granulomas manifesting as multiple masses having an increase fluorodeoxyglucose (FDG) uptake. One case of a new mass was demonstrated as a suspicious mass on the dynamic sequences on MRI of the breast. Ultrasound-guided biopsy demonstrated benign tissue response to silicone. One case demonstrated bilateral ruptured breast implants on breast MRI, as well as bilateral axillary and mediastinal lymphadenopathy. Eventually, the patient underwent bronchoscopy for pulmonary workup of dry cough, revealing sarcoidosis.

Conclusion

Silicone granulomas can manifest as masses with suspicious morphology and enhancement dynamics on breast MRI or with increased FDG uptake on PET CT. The presence of silicone implants and awareness of the possibility of a rupture and formation of silicone granulomas may help in facilitating a correct diagnosis.     

Paraffinoma in anterior abdominal wall mimicking liposarcoma

Paraffinoma of breast is a recognized complication of paraffin injection for breast augmentation. Liquid paraffin can extend along fascial planes to involve adjacent tissues. A rare case of paraffinoma in anterior abdominal wall, which was misdiagnosed as a soft tissue liposarcoma before surgical excision, is reported. It was heterogeneous with marked posterior acoustic shadowing and small peripheral cysts on ultrasound. On MRI, it had ill-defined margins and was heterogeneous in signal intensity. Small round components which were hypointense on all sequences were demonstrated. There is significant overlapping of imaging features between paraffinoma and soft tissue liposarcoma. Histological differentiation from well-differentiated liposarcoma may also be difficult. A detailed clinical history of previous paraffin injection for breast augmentation is very important for correct interpretation of imaging and histopathological findings.     

Lumpy silicone-injected breasts: enhanced MRI and microscopic correlation

Clinical images emphasizing on magnetic resonance imaging (MRI) characteristics of silicone-injected breasts with microscopic correlation were presented. A total of 16 patients with a history of silicone injection breast augmentation received MRI examinations due to palpable masses were reviewed. MRI enables the demonstration of the characteristic MR intensities in silicone-injected breasts. Four breast cancers were accurately detected by the enhancement technique including the cancers admixing within the fibrosis and silicone granuloma. This article can document the excellent ability of MRI with high microscopic correlation in examining these clinical, mammographic and ultrasonographic difficult cases. Understanding the MRI features is helpful to approach these patients. On the other hand, these illustrations indicated the importance of enhancement technique in detecting the cancers and in differentiating the angiogenic lesions from nonenhanced silicone granulomas.     

MR imaging of the augmented breast

Mammographic evaluation of the augmented breast is challenging, since breast implants obscure significant amount of breast tissue while diminishing the effect of compression. Posttherapeutic scarring can make mammographic interpretation even more difficult. MRI has thus evolved into the modality of choice for diagnosing implant complications as well as detection of primary or recurrent breast cancer in these patient population. The present article attemps to give an overview of the MR findings of different breast augmentation and reconstruction techniques, i. e. prosthetic breast implants, breast reconstruction with autogenous tissue, free silicone injections and fat grafts, and their complications. Received 16 April 1997; Revision received 28 July 1997; Accepted 29 July 1997     

Silicone-selective multishot echo-planar imaging for rapid MRI survey of breast implants

The purpose of this study was to assess the usefulness of silicone-selective multishot echo-planar imaging (EPI) for the rapid magnetic resonance imaging (MRI) survey of breast implants. Twenty patients with bilateral breast implants underwent MRI. The use of inversion recovery and magnetization transfer pulses led to silicone-selective images. The rapid MRI survey required only 43 s, which accurately distinguished between silicone and non-silicone materials in the implants, and therefore induced the final MRI sequences appropriate for the detailed characterization of the implants. In 5 of the 20 patients, the rapid MRI survey showed implanted materials that were not indicated from clinical information. This silicone-selective multishot EPI allows a rapid survey of breast implants, which is useful to avoid unnecessary sequences in these patients.