Department of Diagnostic and Interventional Radiology, University of Aachen, RWTH, Pauwelsstr. 30, 52074, Aachen, Germany.
Eur Radiol. 2022 Nov;32(11):7430-7438. doi: 10.1007/s00330-022-08809-0. Epub 2022 May 7.
Levonorgestrel-releasing intrauterine contraceptive devices (LNG-IUDs) are designed to exhibit only local hormonal effects. There is an ongoing debate on whether LNG-IUDs can have side effects similar to systemic hormonal medication. Benign background parenchymal enhancement (BPE) in dynamic contrast-enhanced (DCE) MRI has been established as a sensitive marker of hormonal stimulation of the breast. We investigated the association between LNG-IUD use and BPE in breast MRI to further explore possible systemic effects of LNG-IUDs.
Our hospital database was searched to identify premenopausal women without personal history of breast cancer, oophorectomy, and hormone replacement or antihormone therapy, who had undergone standardized DCE breast MRI at least twice, once with and without an LNG-IUD in place. To avoid confounding aging-related effects on BPE, half of included women had their first MRI without, the other half with, LNG-IUD in place. Degree of BPE was analyzed according to the ACR categories. Wilcoxon-matched-pairs signed-rank test was used to compare the distribution of ACR categories with vs. without LNG-IUD.
Forty-eight women (mean age, 46 years) were included. In 24/48 women (50% [95% CI: 35.9-64.1%]), ACR categories did not change with vs. without LNG-IUDs. In 23/48 women (48% [33.9-62.1%]), the ACR category was higher with vs. without LNG-IUDs; in 1/48 (2% [0-6%]), the ACR category was lower with vs. without LNG-IUDs. The change of ACR category depending on the presence or absence of an LNG-IUD proved highly significant (p < 0.001).
The use of an LNG-IUD can be associated with increased BPE in breast MRI, providing further evidence that LNG-IUDs do have systemic effects.
• The use of levonorgestrel-releasing intrauterine contraceptive devices is associated with increased background parenchymal enhancement in breast MRI. • This suggests that hormonal effects of these devices are not only confined to the uterine cavity, but may be systemic. • Potential systemic effects of levonorgestrel-releasing intrauterine contraceptive devices should therefore be considered.
左炔诺孕酮宫内节育器（LNG-IUD）旨在仅表现出局部激素效应。目前仍在争论 LNG-IUD 是否会产生类似于全身激素药物的副作用。动态对比增强（DCE）MRI 中的良性背景实质增强（BPE）已被确立为乳房激素刺激的敏感标志物。我们研究了 LNG-IUD 使用与乳房 MRI 中的 BPE 之间的关联，以进一步探讨 LNG-IUD 可能的全身作用。
我们在医院数据库中搜索了无乳腺癌个人史、卵巢切除术和激素替代或抗激素治疗史的绝经前妇女，这些妇女至少进行了两次标准化 DCE 乳房 MRI 检查，一次有 LNG-IUD，一次无 LNG-IUD。为了避免混杂与衰老相关的 BPE 影响，纳入的一半女性首次 MRI 时未放置 LNG-IUD，另一半女性首次 MRI 时放置了 LNG-IUD。根据 ACR 类别分析 BPE 程度。使用 Wilcoxon 配对符号秩检验比较有和无 LNG-IUD 时 ACR 类别的分布。
共纳入 48 名女性（平均年龄 46 岁）。在 48 名女性中的 24 名（50%[95%CI：35.9-64.1%]）中，有和无 LNG-IUD 时，ACR 类别未发生变化。在 48 名女性中的 23 名（48%[33.9-62.1%]）中，有 LNG-IUD 时 ACR 类别更高；在 48 名女性中的 1 名（2%[0-6%]）中，有 LNG-IUD 时 ACR 类别更低。有和无 LNG-IUD 时 ACR 类别的变化具有高度显著性（p<0.001）。
使用 LNG-IUD 可能与乳房 MRI 中的 BPE 增加有关，这进一步表明 LNG-IUD 确实具有全身作用。
• 左炔诺孕酮宫内节育器的使用与乳房 MRI 中的背景实质增强增加有关。• 这表明这些器械的激素作用不仅局限于子宫腔，而且可能是全身性的。• 因此，应考虑左炔诺孕酮宫内节育器的潜在全身作用。
