Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama

OBJECTIVE. Silicone gel breast implants have been reported to rupture, but the prevalence of implant rupture in an unreferred population of women is not known. The objective of this study was to assess the prevalence of implant rupture and the presence of extracapsular silicone gel in an unreferred population of women without regard to the absence or presence of any local or systemic symptoms. SUBJECTS AND METHODS. Women identified as part of a National Cancer Institute cohort study on breast implants, living in the Birmingham, AL, area were invited to undergo MR imaging of their current silicone gel breast implants at the Kirklin Clinic at the University of Alabama at Birmingham. Three radiologists independently examined and rated all MR images for signs of implant rupture and extracapsular silicone. RESULTS. A total of 344 women with silicone gel breast implants underwent MR imaging. Breast implant rupture was reported by at least two of three radiologists for 378 (55.0%) of the 687 implants in this study. Another 50 implants (7.2%) were rated as indeterminate (suspicious) for rupture. A majority of women in this study, 265 (77.0%) of 344, had at least one breast implant that was rated as ruptured or indeterminate. Radiologists also agreed that silicone gel could be seen outside the fibrous capsule that forms around the implant in 85 (12.4%) of the 687 implants affecting 73 women (21.2%). Factors that affected implant rupture were implant age and location (submuscular or subglandular). The median implant age at rupture was estimated to be 10.8 years with a 95% confidence interval of 8.4-13.9 years. CONCLUSION. The prevalence of silent or occult silicone gel breast implant rupture is higher than was previously suspected. Most women in this study had MR imaging evidence of at least one ruptured silicone gel breast implant.     

乳房假体植入后破裂及漏出的MRI表现

目的 探讨MRI诊断乳房假体破裂和(或)泄漏的临床价值. 资料与方法 对15例隆乳术后患者行MR扫描,对囊袋假体及注射聚丙烯酰胺假体的MR表现进行分类分析,与正常假体对照. 结果 硅胶囊袋单腔假体13例26个,囊内为硅胶液;1例2个为双囊假体,外囊为生理盐水,内囊为硅胶液.其中正常假体5例,均为单囊硅胶囊袋假体.硅胶囊袋单腔假体破裂8例16个,其中1例属囊内破裂,MRI示残留塌陷的硅胶囊袋呈长条状长T1、短T2信号;其余为囊内、外均破裂,MRI示假体内有多发条、丝状长T1短T2信号,即"条丝征"、"舌样征",同侧乳房外见假体内容物颗粒.注射聚丙烯酰胺假体1例2个,完全破裂,表现为多发条块状、结节状长T1、长T2信号,MRI表现为假体内有多发"条丝征". 结论 MR检查可明确乳房假体的类型、位置;明确假体破裂的类型及漏出物的分布范围;因此能为临床手术提供准确定位,为随访复查提供客观资料.     

乳房假体植入后破裂及泄漏的MRI表现

目的：探讨磁共振诊断乳房假体破裂和（或）泄漏的临床价值。方法：对17例隆乳术后患者行MR扫描，对1个体外正常硅胶液硅胶囊袋假体行相同序列MR扫描作为正常参照。对囊袋假体及注射聚丙烯酰胺假体的MR表现进行分类分析。结果：正常硅胶囊袋单腔假体7例12个，其中4例8个囊内为硅胶液；3例4个囊内为生理盐水。生理盐水硅胶囊袋单腔假体破裂2例2个，其中1 个属囊内破裂，MRI示残留塌陷的硅胶囊袋呈长条状长T1、短T2信号；另1个属囊外破裂，MRI示假体内有多条丝状短T2低信号，即“条丝征”，同侧乳房外见假体内容物颗粒。注射聚丙烯酰胺假体10例20个，其中1例2个完整；8例16个完全破裂，表现为多发条块状、结节状长T1、长T2信号，8例中有7例见双侧乳房腺体内及乳房外有注射物颗粒；1例2个内部撕裂，MRI表现为假体内有多发“条丝征”。结论：MR检查可明确乳房假体的类型、位置；明确假体破裂类型及漏出物的分布范围；因此能为临床手术提供准确定位，为随访复查提供客观资料。     

Challenges in mammography: part 2, multimodality review of breast augmentation--imaging findings and complications

OBJECTIVE: Breast augmentation is common throughout the world; however, there is variation in materials and surgical techniques. This review illustrates the mammographic, sonographic, and MRI characteristics of the different types of breast augmentation, including silicone, saline, polyacrylamide gel, and autologous fat augmentation. CONCLUSION: The imaging findings of complications such as implant rupture, free silicone, and fat necrosis in association with augmentation will be illustrated.     

Tubular carcinoma of the breast: mammographic and sonographic features

OBJECTIVE: The purpose of this study was to define specific mammographic and sonographic features of tubular carcinoma of the breast. MATERIALS AND METHODS: Seventeen pathologically confirmed cases of tubular carcinoma were characterized retrospectively by two radiologists. Mammograms and sonograms were available for all patients. RESULTS: Fifteen of the 17 tubular carcinomas appeared as irregularly shaped masses with spiculated margins on mammography. Sixteen of the 17 masses had central densities. Spicules longer than the diameter of the central lesion were noted in eight (53%) of 15 tubular carcinomas. Eight tubular carcinomas had associated calcifications, with calcifications suspected of being malignant in four cases. On sonography, 15 hypoechoic masses were seen. The margins of the masses on sonography were described as ill-defined in 14 (93%) of the 15 cases. Posterior acoustic shadowing was present in 14 of the 15 cases. CONCLUSION: Tubular carcinomas are usually seen on mammography as irregularly shaped masses with central densities and spiculated margins, and most tubular carcinomas can be identified on sonography as hypoechoic masses with ill-defined margins and posterior acoustic shadowing. Although the mammographic and sonographic features of tubular carcinoma are not sufficiently specific to differentiate tubular carcinomas from radial scars, sonography can be useful for guiding biopsies and evaluating for multifocal and multicentric disease.     

Augmentation mammoplasty: normal and abnormal findings with mammography and US.

A retrospective review of 133 patients who had undergone augmentation mammoplasty (n = 122), reconstructive mammoplasty (n = 10), and silicone injections (n = 1) was undertaken to establish the normal appearance of various types of implants, to establish a range of normal variations (wrinkles, valves, minor bulges), and to recognize true implant complications (collapse of a saline prosthesis, leakage of silicone gel, capsular contracture, capsular calcification, and deformities). The detection and evaluation of breast parenchymal abnormalities in the presence of a radiopaque implant are more difficult, and frequently ultrasound (US) or special mammographic views in conjunction with physical examination are required. Coned-down compression spot views are suggested for asymmetric opacities or ill-defined mammographic masses, and magnification views are recommended for microcalcifications: Both should be obtained with the Eklund implant displacement technique. Tangential or other special views combined with US are best for the evaluation of palpable abnormalities and suspected silicone implant rupture.     

The diagnosis of breast implant rupture: MRI findings compared with findings at explantation

STUDY OBJECTIVE: The aim of this study was to evaluate the accuracy of Magnetic Resonance Imaging (MRI) as performed according to a strict study protocol in diagnosing rupture of silicone breast implants. MATERIAL AND METHODS: The study population consisted of 64 women with 118 implants, who had participated in either one or two study MRI examinations, aiming at determining the prevalence and incidence of silent implant rupture, respectively, and who subsequently underwent explantation. Implant rupture status was determined by four independent readers and a consensus diagnosis of either rupture (intracapsular or extracapsular), possible rupture or intact implant was then obtained. Strict predetermined rupture criteria were applied as described in this report and findings at surgery were abstracted in a standardised manner and results compared. RESULTS: At MRI, 66 implants were diagnosed as ruptured, nine as possibly ruptured and 43 as intact. Among the ruptured implants, 27 were categorized as extracapsular. At surgery, on average 297 days after the MRI, 65 of the 66 rupture diagnoses were confirmed, as were 20 of the cases with extracapsular silicone. Eight of the nine possibly ruptured implants were in fact ruptured at surgery. Thirty-four of the 43 intact implants were described as intact at surgery. When categorising possible ruptures as ruptures, there were one false positive and nine false negative rupture diagnoses at MRI yielding an accuracy of 92%, a sensitivity of 89%, and a specificity of 97%. Correspondingly, the predictive value of a positive MRI examination was 99% and the predictive value of a negative MRI examination was 79%. CONCLUSIONS: We conclude that MRI is highly accurate for identification of silicone breast implant rupture, with a high sensitivity and specificity when evaluation of images are based on presence of well-defined rupture criteria.     

Mammographic appearance following implant removal.

Potential complications of augmentation mammaplasty with silicone gel breast implants have been the subject of much recent debate in the medical and lay communities. Some women have undergone implant removal, and others may follow. The mammographic appearance following submammary implant removal in four women and the histologic appearance in one case are described. Bilateral symmetric soft-tissue masses posterior to the glandular tissue with accompanying calcifications should suggest the diagnosis. The radiologist should be familiar with the mammographic appearance following implant removal. Such knowledge may prevent unnecessary concern and unwarranted biopsy.     

Magnetic resonance imaging of Trilucent TM breast implants

AIM: To demonstrate the magnetic resonance imaging (MRI) appearances of intact and ruptured Trilucent TM implants with imaging and surgical correlation. The appearances of the implant transponder artefact are also described MATERIALS AND METHODS: A retrospective review of the MRI findings in 34 patients with bilateral subpectoral Trilucent TM breast implants (Lipomatrix, Inc./Collagen Aesthetics International Inc., Neuchatel, Switzerland) was performed. Patients under implant surveillance and those with suspected implant rupture formed the study group. Imaging findings were correlated with surgical appearances. RESULTS: Surgical correlation was available in 53% of patients. Fifty per cent (18/36) of implants were intact at surgery, 50% (18/36) of implants were ruptured. Of the 18 ruptured implants, 17 were intracapsular ruptures and one an extracapsular rupture. The sensitivity of MRI for detection of intracapsular rupture in Trilucent TM breast implants was 82% specificity 76%, positive predictive value 78%, negative predictive value 81% and accuracy 79% in this study group. No case of implant rupture was obscured by the transponder artefact. Four implants were found to have 'pseudocapsules' at surgery (5.9%), the implants were intact with fluid present between the implant and capsule. Only one pseudocapsule was demonstrated on MRI. CONCLUSION: Magnetic resonance imaging is currently the most accurate technique for diagnosis of implant rupture in Trilucent TM breast implants. Transponder artefact does not appear to interfere with the assessment of implant rupture.     

Screening mammography in 350 women with breast implants: prevalence and findings of implant complications.

OBJECTIVE. A series of screening mammograms in asymptomatic women with breast implants was reviewed to determine the prevalence of clinically silent sequelae of breast augmentation and to analyze the mammographic findings. MATERIALS AND METHODS. The screening mammograms of 350 consecutive women with implants were reviewed retrospectively by experienced mammographers. Any women who reported problems had a diagnostic examination and therefore were not included in our sample. Mammographic features of sequelae specific to implantation such as development of a fibrous capsule, periprosthetic calcification, implant herniation, and silicone leaks were tabulated. Additionally, modified compression (push-back) views, when obtained, were evaluated for their usefulness. RESULTS. Fibrous encapsulation of breast implants was seen in 257 (73%) of 350 women. Periprosthetic calcification was seen in 90 (26%), and 60 women (17%) had implant herniations. Sixteen women (5%) had implant failure as evidenced by silicone leak. Two of these women had bilateral implant failures. Surgical confirmation was attainable in only five of 16 women. Analysis of modified compression views demonstrated an overall improvement in visualization of breast tissue with this technique. Although the sample size is small, there was a significant increase in the amount of breast tissue seen with push-back views in women with submuscular implants. CONCLUSION. Our analysis revealed a wide range of mammographic findings in this group of asymptomatic women with breast augmentation. Especially worrisome is the 5% prevalence of unsuspected silicone extravasation. Additionally, we have demonstrated the usefulness of push-back views in this screening group, especially in women with submuscular implants.     

Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis

The aim of this study was to describe the mammographic and sonographic findings of idiopathic granulomatous mastitis which is a rare inflammatory disease of the breast of unknown etiology. The clinical, radiologic, and pathologic features of 12 cases with idiopathic granulomatous mastitis were retrospectively reviewed. Mammography was performed in all cases, 8 of which showed a focal asymmetric density, 3 had a mass with irregular margins, and 1 had no abnormality. Sonography was performed in 10 cases, and a focal area with inhomogeneous and hypoechoic pattern was depicted in 6 cases, 4 of which were associated with internal tubular hypoechoic structures. One case revealed a hypoechoic mass consistent with malignancy. In 1 case sonography showed an edematous pattern involving nearly the entire breast. Two patients had normal sonograms. If a focal asymmetric density is seen in mammography and inhomogeneous hypoechogenity with internal hypoechoic tubular structures accompany ultrasonographically, these findings should suggest the possibility of idiopathic granulomatous mastitis; however, very often idiopathic granulomatous mastitis mimics a breast carcinoma clinically and the final diagnosis should be reached histopatologically due to high false-positive and false-negative mammographic appearances. Electronic Publication     

Sonography of neck masses in children

The sonograms and medical records of 49 patients were reviewed to determine if there is a characteristic sonographic appearance for certain neck masses. Neck masses included: inflammatory masses (12), noninflammatory masses (23), and thyroid masses (14). Four entities including thyroglossal duct cyst, fibromatosis colli, cystic hygroma, and multiple lymphadenopathy showed characteristic sonographic appearance. Thyroglossal duct cysts were seen as midline or slightly off midline cystic masses. A sinus tract extending superiorly was nicely demonstrated in one patient. The mass in fibromatosis colli (neonatal torticollis) appeared as a well defined mass clearly within the sternocleidomastoid muscle, uniformly echogenic, but less echogenic than the normal surrounding muscle, without good through-transmission. A cystic or primarily cystic mass with linear septations was the characteristic finding of the cystic hygroma. Multiple lymphadenopathy demonstrated multiple discrete, oval, relatively hypoechoic masses along the cervical lymphatic chain. The sonographic appearance of inflammatory masses was variable, being either inhomogeneously echogenic or of mixed echogenicity. Hemangiomas were either echogenic with cystic vascular spaces or linear septations or relatively homogeneously echogenic. Intrinsic thyroid masses could be distinguished from extrinsic masses in most cases. The demonstration of calcification in a mass was useful in narrowing the differential diagnosis. Although it is not a specific finding, the presence of calcification highly suggests a neoplastic lesion, particularly neuroblastoma or teratoma. Not only can the location, extent, and internal characteristics of a mass be determined, but in certain entities, the sonographic appearance is characteristic and an accurate diagnosis can be made.     

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.     

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     

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。     

Correlation of single-lumen silicone implant integrity with chemical shift artifact on T2-weighted magnetic resonance images

PURPOSE: To correlate the integrity of single-lumen silicone gel implants with chemical shift artifact (CSA) associated with infolding of the elastomer shell. MATERIALS and METHODS: The T2-weighted images of presurgical MRI examinations of 54 implants were retrospectively reviewed by two breast radiologists blinded to the operative and pathologic findings. CSA associated with intraluminal membranes was quantified by determining the fraction of membranes with it and categorized as minimal (0-1/3 of membranes involved), moderate (>1/3- <2/3), and marked (2/3 to all). CSA was qualified by noting whether CSA intensity of the membranes was less than or similar to that of blood vessels. The CSA was correlated with the surgical or pathology findings to judge integrity of the implant. RESULTS: Nineteen implants were intact, 35 were dysfunctional (gel leakage or rupture). Twenty-eight of 29 (97%) with a minimal fraction of membranes with CSA were dysfunctional; 17/21 (81%) with CSA associated with a marked fraction of membranes were intact (P < 0.001). All 28 implants with CSA intensity less than vessels were dysfunctional, 19/26 (73%) with CSA equal to vessels were intact (P < 0.001). All 25 implants with minimal CSA and intensity less than vessels were dysfunctional. Seventeen of 19 (89%) implants with CSA associated with a marked fraction of membranes and intensity equal to vessels were intact (P = 0.02). The magnetic resonance imaging (MRI) signs were combined with strong CSA as a predictor of integrity, and 22 of 26 (85%) implants were correctly diagnosed, 4 dysfunctional and 18 intact (P < 0.0001). CONCLUSION: CSA correlates with integrity of silicone gel implants on T2-weighted images and can be used with other MRI signs to improve diagnosis.     

Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience

Purpose

This study was done to determine mammographic, sonographic and magnetic resonance imaging (MRI) appearances of idiopathic granulomatous mastitis, an entity clinically and radiographically resembling breast carcinoma.

Materials and methods

A total of 36 women (mean age 37 years, range 21?C51 years) with histopathological diagnosis of idiopathic granulomatous mastitis were enrolled in the study. The Breast Imaging Reporting and Data System (BI-RADS) was used to categorise the levels of suspicion of malignancy on mammography. Mammography findings were classified also according to density, margin, architectural distortion and number of lesions. Lesions were classified according to number, heterogeneity and echogenic features on sonography. Dynamic MRI findings were categorised as enhancing mass lesion, nonmass lesion or both mass lesions and nonmass lesions together. Subclassification criteria for MRI included lesion shape, margin, border and internal enhancement pattern.

Results

The most common mammographic finding was either focal or diffuse asymmetric density (n=15, 44%). The most common sonographic findings were solitary or multiple circumscribed heterogeneous hypoechoic masses (n=19, 52%). Among other sonographic findings were diffuse abscess formation with fistulae and massive parenchymal heterogeneity and hypoechogenicity in 12 (33%) and five (13%) women, respectively. On MRI, enhancing mass lesions were detected in 24 patients, whereas enhancing nonmass lesions were observed in 28. Sixteen patients had both enhancing mass lesions and nonmass lesions together.

Conclusions

Although not characteristic for this entity, asymmetric density on mammography, solitary or multiple clustered heterogeneous hypoechogenicity with a tubular configuration on sonography and round, smooth-contoured masslike lesion with rim enhancement or segmental non-mass-like lesion on MRI are the most common features of the disease.     

Intrapleural silicone granuloma mimicking pleural malignancy

We describe a 78-year-old initially presenting with left breast cancer, status post mastectomy and bilateral dual-lumen breast implant placement, subsequently developed lung cancer years later status post lobectomy, who later developed FDG-avid pleural nodularity and thickening. The differential diagnosis of pleural thickening and nodularity can be broad, including metastatic cancer, asbestos-related pleural disease, loculated fluid (including simple pleural effusion, hemothorax, or chylothorax), and pleural infection. However, in the setting of two different primary malignancies, our patient''s FGD-avid pleural thickening was concerning for metastatic disease. Further workup with a core-needle biopsy of the pleural nodule revealed “droplets of foreign material and foreign body giant cell reaction consistent with contents of ruptured medical device”, without evidence of malignancy. Prior imaging did not indicate breast implant compromise. A subsequent mammogram suggested findings of bilateral implant rupture, however, no further clinical workup was performed. A screening mammogram a decade later indicated possible extracapsular silicone within the right breast and left mastectomy site and an MRI was recommended for further workup. Subsequent MRI showed bilateral extracapsular silicone implant rupture with a thick layer of silicone signal within the left pleura in a similar distribution to her pleural thickening and nodularity. Her breast MRI findings, in conjunction with her pleural biopsy result, are concordant with pleural silicone granulomas from extracapsular breast implant rupture via radio-occult tract from prior left lobectomy procedure.     

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。