聚丙烯酰胺水凝胶注射隆乳后MRI检查方案及临床价值分析

目的:探讨聚丙烯酰胺水凝胶(polyamide hydrogel,PAMHG)注射隆乳后磁共振(magnetic resonance image,MRI)检查的标准化方案及临床应用价值。方法:30例曾注射PAMHG隆乳后取出术前的患者(共60只乳腺)行双侧乳腺MRI检查,其中14例行增强MRI,对MRI表现与手术、病理结果对照分析。结果:PAMHG于T1加权成像(T1-weighted image,T1WI)表现为与腺体相等信号,快速自旋回波(Turbo Spin Echo,TSE)T2加权成像(T2-weighted imaging,T2WI)即TSE-T2WI为高信号,结合特异性选择衰减反转恢复技术(Spectrally Selective Attenated Inversion Recovery,SPAI R)进行脂肪抑制(Fat Saturation,FS)的TSE-T2WI-SPAI R脂肪抑制(fat saturation,FS)像表现为明显高信号。其中83.3%(50/60)的乳腺中PAMHG内可见多发低信号间隔,83.3%(50/60)的乳腺中PAMHG无光滑囊壁;10%(6/60)PAMHG形态规则,可见边缘光滑均匀的囊壁;6.7%(4/60)PAMHG囊壁边缘不规则。PAMHG分布于皮下形成硬结占66.7%(40/60),分布于腺体内形成硬结占16.7%(10/60),分布于胸大肌下呈条带状占83.3%(50/60),乳腺后方肋间肌肌间隙出现PAMHG游走占16.7%(10/60)。所有PAMHG均无对比增强,增强后发现伴发的恶性导管内乳头状瘤及纤维腺瘤各1例。结论:横轴位T1WI、TSE-T2WI-SPAI R脂肪抑制像、矢状位TSE-T2WI-SPAIR脂肪抑制像结合多时相增强MRI为PAMHG注射隆乳后MRI检查的理想方案,对术前判定PAMHG分布及术后随访有重要的临床意义。

The protocol and value of MRI for augmentation mammaplasty by injected polyacrylamide hydrogel

Objective To explore the standardization protocol and value of magnetic resonance imageing(MRI) for augmentation mammaplasty by injected polyacrylamide hydrogel(PAMHG).Methods Thirty female patients with 60 breast,having been injected PAMHG as augmentation mammaplasty,underwent bilateral breast MRI examination before removal surgery.14 patients among them underwent dynamic contrast enhanced MRI(DCE-MRI).The results of MRI were compared with that of operation and pathology.Results PAMHG showed iso-intensity compared with breast gland on T1-Weighted imaging(T1WI) and hyperintensity on Turbo Spin Echo(TSE)T2WI with Spectrally Selective Attenated Inversion Recovery(SPAIR.Low signal septa were noted within PAMHG in 83.3%(50/60) breast,83.3%(50/60) PAMHG without capsule,10%(6/60) with smooth and regular capsule,6.7%(4/60) PAMHG with irregular capsule.Subcutaneous lump of PAMHG was 66.7%(40/60),lump of that in breast gland was 16.7%(10/60).Diffuse gel along spatium intermusculare of pectoralis major was 83.3%(50/60),that along spatium intermusculare of intercostal muscle was 16.7%(10/60).All PAMHG in breast of 14 patients showed no enhancement,one malignant intraductal papilloma and one fibroadenoma in breast were found in two patients.All distributions of PAMHG and appearances of its complications on T2WI-FS were consistent with the results of operation.Conclusions Axial T1WI,TSE-T2WI-SPAIR and sagittal TSE-T2WI-SPAIR combined with DCE-MRI can be optimized protocol of MRI examination for augmentation mammaplasty by injected polyacrylamide hydrogel.MRI is helpful for preoperative assessment of the distribution of PAMHG and follow up after operation.