Middleton M S
Robert N. Berk Magnetic Resonance Institute, UCSD Department of Radiology, San Diego, California 92103-8749, USA.
Top Magn Reson Imaging. 1998 Apr;9(2):92-137. doi: 10.1097/00002142-199804000-00003.
After several years of research in many disciplines, concern for the safety of silicone gel-filled breast implants continues. Although systemic effects of silicone are debated, there is growing consensus that implant rupture and other local breast complications from implants are very real concerns. This paper reviews the history of breast augmentation with an emphasis on the great variety of implants manufactured during the last generation. A classification scheme consisting of 14 breast implant categories is described, and the MR appearance of many is illustrated. The MR signs of implant rupture and pitfalls associated with those signs are reviewed. Indications and contraindications for MR imaging of implants and soft tissue silicone are presented. The author's breast implant and soft-tissue silicone MR imaging experience with follow-up surgical experience over the last 6 years is summarized and discussed. For 1,626 single lumen silicone gel-filled implants imaged, the sensitivity for rupture was 74% and the specificity was 98%. For those implants, 64.9% showed no evidence rupture on MR, 7.9% were indeterminate, and 27.2% were definitely ruptured. Of those that were ruptured, 26.2% had silicone outside as well as within the fibrous capsule. Of the 442 implants that were shown to be ruptured, 54.8% were in a state of uncollapsed rupture, 12.9% minimally collapsed rupture, 4.1% partially collapsed rupture, and 28.3% fully collapsed rupture.
经过多个学科数年的研究，对于硅胶填充乳房植入物安全性的担忧依然存在。尽管硅胶的全身影响存在争议，但越来越多的人达成共识，即植入物破裂及其他乳房局部并发症是切实存在的问题。本文回顾了隆乳术的历史，重点介绍了上一代生产的种类繁多的植入物。描述了一个由14种乳房植入物类别组成的分类方案，并展示了许多植入物的磁共振成像表现。回顾了植入物破裂的磁共振成像征象以及与这些征象相关的陷阱。介绍了植入物和软组织硅胶磁共振成像的适应证和禁忌证。总结并讨论了作者在过去6年中乳房植入物和软组织硅胶磁共振成像经验以及后续手术经验。对于1626个单腔硅胶填充植入物进行成像，破裂的敏感度为74%，特异度为98%。对于这些植入物，64.9%在磁共振成像上未显示破裂迹象，7.9%结果不确定，27.2%肯定破裂。在破裂的植入物中，26.2%在纤维囊内外均有硅胶。在442个显示破裂的植入物中，54.8%处于未塌陷破裂状态，12.9%为最小塌陷破裂，4.1%为部分塌陷破裂，28.3%为完全塌陷破裂。
