Study of breast implant rupture: MRI versus surgical findings

PURPOSE: This study evaluated the role of breast magnetic resonance (MR) imaging in the selective study breast implant integrity. MATERIALS AND METHODS: We retrospectively analysed the signs of breast implant rupture observed at breast MR examinations of 157 implants and determined the sensitivity and specificity of the technique in diagnosing implant rupture by comparing MR data with findings at surgical explantation. RESULTS: The linguine and the salad-oil signs were statistically the most significant signs for diagnosing intracapsular rupture; the presence of siliconomas/seromas outside the capsule and/or in the axillary lymph nodes calls for immediate explantation. CONCLUSIONS: In agreement with previous reports, we found a close correlation between imaging signs and findings at explantation. Breast MR imaging can be considered the gold standard in the study of breast implants.     

乳腺假体破裂及漏出的MRI诊断

隆乳术因近年来的广泛开展,使得术后并发症的发现日益增多。MRI检查因其在多参数及多平面成像上具有的优势,使之成为观察乳腺假体位置、有无破裂及漏出等并发症以及周围腺体内有无病变的最佳评价影像学方法。1材料与方法1.1一般资料女性隆乳术患者20例,年龄分布35～49岁,平均39.3     

MRI screening for silicone breast implant rupture: accuracy,inter- and intraobserver variability using explantation results as reference standard

Objectives

The recall of Poly Implant Prothèse (PIP) silicone breast implants in 2010 resulted in large numbers of asymptomatic women with implants who underwent magnetic resonance imaging (MRI) screening. This study’s aim was to assess the accuracy and interobserver variability of MRI screening in the detection of rupture and extracapsular silicone leakage.

Methods

A prospective study included 107 women with 214 PIP implants who underwent explantation preceded by MRI. In 2013, two radiologists blinded for previous MRI findings or outcome at surgery, independently re-evaluated all MRI examinations. A structured protocol described the MRI findings. The ex vivo findings served as reference standard.

Results

In 208 of the 214 explanted prostheses, radiologists agreed independently about the condition of the implants. In five of the six cases they disagreed (2.6 %), but subsequently reached consensus. A sensitivity of 93 %, specificity of 93 %, positive predictive value of 77 % and negative predictive value of 98 % was found. The interobserver agreement was excellent (kappa value of 0.92).

Conclusions

MRI has a high accuracy in diagnosing rupture in silicone breast implants. Considering the high kappa value of interobserver agreement, MRI appears to be a consistent diagnostic test. A simple, uniform classification, may improve communication between radiologist and plastic surgeon.

Key points

? MRI has a high accuracy in diagnosing rupture in silicone breast implants. ? MRI appears to be a consistent diagnostic test with excellent interobserver agreement. ? A simple, uniform classification system, improves communication between radiologist and plastic surgeon. ? The interobserver agreement on implant rupture is higher than on extracapsular leakage.     

跟腱断裂的MRI表现

目的 分析跟腱断裂的MRI表现.方法 回顾性分析7例跟腱断裂的MRI表现.7例均行常规MR轴面T_1WI、T_2WI,矢状面T_1WI、T_2WI和频率敏感脂肪抑制(SPIR)序列扫描.结果 完全性跟腱断裂6例,部分性跟腱断裂1例,跟腱断裂部位发生于跟腱附着于跟骨部位上方2.6～11.0 cm,平均5.4 cm.跟腱断裂的MRI表现为跟腱肿大增粗(7例)、变形,呈波浪状(2例).跟腱纤维部分或完全不连续和腱内信号强度增强(7例),完全性跟腱断裂的裂隙宽度为3.0～8.0 mm,断端水肿、充满血液,于MR T_2WI和SPIR呈高信号.7例跟腱断裂在T_1WI均呈中等信号;在T_2WI 1例呈中等信号,3例呈中-高信号,3例呈高信号;在SPIR 2例呈中-高信号,5例呈高信号.跟腱前脂肪垫模糊,见于6例完全性跟腱断裂.结论 MRI能较好显示跟腱断裂和明确诊断.     

Intracapsular implant rupture: MR findings of incomplete shell collapse

The objective of this study was to determine the frequency and significance of the MR findings of incomplete shell collapse for detecting implant rupture in a series of surgically removed breast prostheses. MR images of 86 breast implants in 44 patients were studied retrospectively and correlated with surgical findings at explanation. MR findings included (a) complete shell collapse (linguine sign), 21 implants; (b) incomplete shell collapse (subcapsular line sign, teardrop sign, and keyhole sign), 33 implants; (c) radial folds, 31 implants; and (d) normal, 1 implant. The subcapsular line sign was seen in 26 implants, the teardrop sign was seen in 27 implants, and the keyhole sign was seen in 23 implants. At surgery, 48 implants were found to be ruptured and 38 were intact. The MR findings of ruptured implants showed signs of incomplete collapse in 52% (n = 25), linguine sign in 44% (n = 21), and radial folds in 4% (n = 2). The linguine sign perfectly predicted implant rupture, but sensitivity was low. Findings of incomplete shell collapse improved sensitivity and negative predictive values, and the subcapsular line sign produced a significant incremental increase in predictive ability. MRI signs of incomplete shell collapse were more common than the linguine sign in ruptured implants and are significant contributors to the high sensitivity and negative predictive values of MRI for evaluating implant integrity.     

MR detection of breast implant rupture.

Breast implant rupture can be difficult to diagnosis. Various modalities including direct clinical palpation, ultrasound, CT, and mammography have been used to evaluate for the presence of prosthesis rupture. We report a case in which the presence of breast implant rupture was determined using MR with characterization of the inflammatory reaction in the soft tissues around the implant. The absence of ionizing radiation with MR makes it especially well suited for evaluating implant rupture in younger patients in whom breast irradiation should be minimized.     

三尖瓣闭锁的MRI诊断(兼与超声心动图和心血管造影对照)

目的：评价ＭＲＩ在三尖瓣闭锁诊断中的作用。材料与方法：回顾分析了１４例三尖瓣闭锁的ＭＲＩ所见并与超声心动图（ＵＣＧ）和心血管造影（ＣＡＧ）比较，１０例经手术证实。结果：１４例三尖瓣闭锁中，１３例为肌型闭锁，１例为隔膜型闭锁；心室动脉异常连接３例；合并肺动脉狭窄１０例；合并房间隔膨出瘤１例。ＭＲＩ正确诊断１３例，清晰地显示三尖瓣闭锁的心内结构及１例房间隔膨出瘤。１例心室动脉异常连接未能确定。结论：比较三种影像方法，在三尖瓣闭锁诊断中，ＭＲＩ优于ＵＣＧ，基本达到ＣＡＧ水平。     

Ruptured breast implant: computed tomographic and mammographic findings

We report the computed tomographic and mammographic findings in a patient with a ruptured breast implant. The diagnosis was made by recognition of alteration in prosthesis contour, collapse of the prosthesis envelope, and the presence of free silicone in the breast and axillary region.     

Extra-mammary findings in breast MRI

Objectives  

Incidental extra-mammary findings in breast Magnetic Resonance Imaging (MRI) may be benign in nature, but may also represent a metastasis or another important lesion. We aimed to analyse the prevalence and clinical relevance of these unexpected findings.     

乳腺MRI检查中的乳腺外病变

目的乳腺MRI检查中的乳腺外偶发病变在本质上可能是良性,但可能也是转移或其他重要病变。本研究的目的是探讨这些偶发病变的发生率与临床的相关性。     

外伤性脾破裂的CT诊断与手术对照分析

探讨CT对外伤性脾破裂的诊断价值及对临床治疗的指导意义.认为早期外伤性脾破裂CT表现以脾实质内不规则不均质高低混杂密度影最多见,膈下肝前新月形低密度影是脾破裂腹腔积血最常见的CT征象,CT检查能明确脾脏损伤的部位及范围.     

MRI diagnosis of biceps tendon rupture.

Distal biceps tendon rupture is a rare injury. While plain radiographs are usually not helpful in visualizing the defect, evaluation of the tendon with MRI has proven to be useful as it depicts complete anatomic detail of the tendon and associated structures. Its multiplanar imaging capability and superior soft tissue contrast resolution makes MRI a prime diagnostic tool in the diagnosis of tendon disorders. We report a case of complete rupture of the biceps tendon diagnosed by MRI.