Fw: MR imaging of extracapsular silicone from breast implants:diagnostic pitfalls

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From: " ilena rose " <ilena@...>

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Sent: Wednesday, February 06, 2002 6:32 PM

Subject: MR imaging of extracapsular silicone from breast

implants:diagnostic pitfalls

>

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list

_uid

> s=11804919 & dopt=Abstract

>

> AJR Am J Roentgenol 2002 Feb;178(2):465-72

>

> MR imaging of extracapsular silicone from breast implants: diagnostic

pitfalls.

>

> Berg WA, Nguyen TK, Middleton MS, Soo MS, Pennello G, Brown SL.

>

> Department of Radiology, University of land, University Imaging

Center,

> 419 W. Redwood St., Ste. 110, Baltimore, MD 21201, USA.

>

> OBJECTIVE: We sought to identify pitfalls in recognition of extracapsular

> silicone on MR imaging.

>

> MATERIALS AND METHODS: Three experienced observers reviewed MR images from

> 359 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.

>

>