Ikeda D M, Borofsky H B, Herfkens R J, Sawyer-Glover A M, Birdwell R L, Glover G H
Department of Radiology, Stanford University School of Medicine, Calif. 94305-5105, USA.
Plast Reconstr Surg. 1999 Dec;104(7):2054-62. doi: 10.1097/00006534-199912000-00016.
The objective of this study was to evaluate the relative efficacies of magnetic resonance (MR) imaging, ultrasonography, and mammography in implant rupture detection and to illustrate pitfalls in MR image interpretation. Thirty patients referred by plastic surgeons with suspected breast implant rupture were prospectively evaluated using MR, ultrasonography, and mammography. Imaging examinations were interpreted independently and blindly for implant rupture and correlated to operative findings. Surgical correlation in 16 patients (53 percent) with 31 implants showed 13 (42 percent) were intact, 5 (16 percent) had severe gel bleed, and 13 (42 percent) were ruptured. MR sensitivity was 100 percent and specificity was 63 percent. Accuracy for rupture was 81 percent with MR, higher than with ultrasonography and mammography (77 and 59 percent, respectively). We describe a specific pitfall in MR interpretation, the "rat-tail" sign, composed of a medial linear extension of silicone along the chest wall. Seen in eight cases (four intact, three ruptures, one gel bleed), the rat-tail sign may lead to misdiagnosis of implant rupture if seen in isolation. Magnetic resonance imaging is more accurate and sensitive than ultrasonography and mammography in detecting breast implant rupture. We describe a new sign (rat-tail sign) composed of medial compression of the implant simulating silicone extrusion as a potential false-positive MR finding for rupture. This article presents clinical experience with magnetic resonance, mammography, and ultrasound in the diagnosis of implant rupture and defines and illustrates potential pitfalls of MR interpretation, including the new rat-tail sign.
本研究的目的是评估磁共振成像（MR）、超声检查和乳腺X线摄影在检测植入物破裂方面的相对效能，并阐明MR图像解读中的陷阱。对30例由整形外科医生转诊的疑似乳房植入物破裂患者进行了MR、超声检查和乳腺X线摄影的前瞻性评估。对成像检查进行独立、盲法解读以判断植入物破裂情况，并与手术结果进行对照。16例患者（53%）的31个植入物的手术对照显示，13个（42%）完好，5个（16%）有严重凝胶渗漏，13个（42%）破裂。MR的敏感性为100%，特异性为63%。MR检测破裂的准确率为81%，高于超声检查和乳腺X线摄影（分别为77%和59%）。我们描述了MR解读中的一个特定陷阱，即“鼠尾”征，表现为硅胶沿胸壁的内侧线性延伸。在8例中可见（4例完好，3例破裂，1例凝胶渗漏），单独出现时，“鼠尾”征可能导致植入物破裂的误诊。在检测乳房植入物破裂方面，磁共振成像比超声检查和乳腺X线摄影更准确、更敏感。我们描述了一种新的征象（“鼠尾”征），由植入物的内侧受压模拟硅胶挤出构成，作为MR检测破裂的潜在假阳性表现。本文介绍了磁共振成像、乳腺X线摄影和超声在诊断植入物破裂方面的临床经验，并定义和阐明了MR解读的潜在陷阱，包括新的“鼠尾”征。
