Mundada Pravin, Kohler Romain, Boudabbous Sana, Toutous Trellu Laurence, Platon Alexandra, Becker Minerva
Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211, Geneva 14, Switzerland.
Division of Diagnostic and Interventional Radiology, Sion Hospital, Avenue du Grand-Champsec 80, 1951, Sion, Switzerland.
Insights Imaging. 2017 Dec;8(6):557-572. doi: 10.1007/s13244-017-0575-0. Epub 2017 Oct 4.
UNLABELLED: Injectable fillers are widely used for facial rejuvenation, correction of disabling volumetric fat loss in HIV-associated facial lipoatrophy, Romberg disease, and post-traumatic facial disfiguring. The purpose of this article is to acquaint the reader with the anatomy of facial fat compartments, as well as with the properties and key imaging features of commonly used facial fillers, filler-related complications, interpretation pitfalls, and dermatologic conditions mimicking filler-related complications. The distribution of facial fillers is characteristic and depends on the anatomy of the superficial fat compartments. Silicone has signature MRI features, calcium hydroxyapatite has characteristic calcifications, whereas other injectable fillers have overlapping imaging features. Most fillers (hyaluronic acid, collagen, and polyalkylimide-polyacrylamide hydrogels) have signal intensity patterns compatible with high water content. On PET-CT, most fillers show physiologic high FDG uptake, which should not be confounded with pathology. Abscess, cellulitis, non-inflammatory nodules, and foreign body granulomas are the most common filler-related complications, and imaging can help in the differential diagnosis. Diffusion weighted imaging helps in detecting a malignant lesion masked by injected facial fillers. Awareness of imaging features of facial fillers and their complications helps to avoid misinterpretation of MRI, and PET-CT scans and facilitates therapeutic decisions in unclear clinical cases. KEY POINTS: • Facial fillers are common incidental findings on MRI and PET-CT scans. • They have a characteristic appearance and typical anatomic distribution • Although considered as safe, facial filler injections are associated with several complications • As they may mask malignancy, knowledge of typical imaging features is mandatory. • MRI is a problem-solving tool for unclear cases.
未标注:可注射填充剂广泛用于面部年轻化、矫正与人类免疫缺陷病毒相关的面部脂肪萎缩、进行性面部半侧萎缩症和创伤后面部毁容导致的致残性体积性脂肪流失。本文旨在让读者了解面部脂肪隔的解剖结构,以及常用面部填充剂的特性和关键成像特征、填充剂相关并发症、解读陷阱,以及模仿填充剂相关并发症的皮肤病学状况。面部填充剂的分布具有特征性,取决于浅表脂肪隔的解剖结构。硅胶具有标志性的磁共振成像(MRI)特征,羟基磷灰石钙具有特征性钙化,而其他可注射填充剂具有重叠的成像特征。大多数填充剂(透明质酸、胶原蛋白和聚烷基酰亚胺 - 聚丙烯酰胺水凝胶)具有与高含水量相符的信号强度模式。在正电子发射断层显像 - X线计算机体层成像(PET - CT)上,大多数填充剂显示生理性高氟代脱氧葡萄糖(FDG)摄取,这不应与病理学表现相混淆。脓肿、蜂窝织炎、非炎性结节和异物肉芽肿是最常见的填充剂相关并发症,成像有助于鉴别诊断。扩散加权成像有助于检测被注射的面部填充剂掩盖的恶性病变。了解面部填充剂的成像特征及其并发症有助于避免对MRI和PET - CT扫描的错误解读,并有助于在不明确的临床病例中做出治疗决策。 关键点:• 面部填充剂是MRI和PET - CT扫描中常见的偶然发现。• 它们具有特征性外观和典型的解剖分布 • 尽管被认为是安全的,但面部填充剂注射仍与多种并发症相关 • 由于它们可能掩盖恶性肿瘤,必须了解典型的成像特征。• MRI是解决不明确病例的工具。
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