乳腺硅胶假体植入术后并发症的MRI表现

Imaging Findings of the Complications of Single-lumen Silicone Implantation

目的总结乳腺硅胶假体植入术后并发症的磁共振表现并探讨其影像特征。方法回顾性分析31名患者,共计61例硅胶假体植入后的MRI图像,包括T1WI、T2WI脂肪抑制序列、DWI及T1WI动态增强,观察各序列中假体边缘、形态、信号、强化方式及对周围组织的影响,分析有无并发症并判断并发症的类型。结果 61例假体中包膜挛缩14例,占23%,MRI表现为假体球形变形,包膜厚度超过3mm;内包膜破裂8例,占13.1%,MRI表现为假体周围纤维包膜完整,破裂的硅胶壳向中心塌陷,形成套索征、线征;外包膜破裂4例,占6.6%,MRI表现为假体外纤维包膜破裂,假体内容物泄漏,假体外乳腺组织内或胸大肌后间隙内分布硅胶颗粒;假体感染4例,MRI显示假体增大,边缘模糊,内部信号不均匀,可伴有气体存在,当合并脓肿时可以见到环形强化的脓肿壁。结论 MRI成像在诊断硅胶假体植入术后并发症中具有很高的准确性,对于其MRI表现进行归纳总结,有助于在临床工作中及时发现及诊断并发症,避免患者因延误治疗而造成不可挽回的损伤。

Objective To explore and summarize the imaging findings of complications after single-lumen silicone implantation in MRI, and investigate the characteristic imaging findings of various complications. Methods We conducted a retrospective study to review MR images of 61 breast implants in 31 female patients.MR scanning sequence included T1 weighted images, T2 fat-suppressed sequence images, diffusion weighted images （DWI） and T1 weighted dynamic contrast-enhanced images（DCE）.To observe the margins, shapes, signals and enhanced shapes of implants as well as the surrounding tissues and analysis of the manifestation and type of the complications. Results A total of 61 silicone implants showed evidence of complications including 14 capsular contracture （23%）, MRI shows capsular thickness more than 3 mm and spherical change. Intracapsular rupture 8 cases（13.1%）,fibrous capsule is normal,T2-weighted MR imaging shows the hypointense line within the implant which was caused from the ruptured silicone outer shell collapsing to the center of implant. Extracapsular rupture 4 cases（6.6%）,MRI shows extra-capsular ruptured and the content overflowed . Free silicone can be detected in breast tissue or post ectopectoralis .There were 4 cases（6.6%） of infections,MRI featured enlarged volume of breast, and blurred margins of implants with the presence of gas occasionally. When merging abscessed can see peripheral wall of the abscess with ring-enhancement. Conclusion MRI has high accuracy in the postoperative complications of breast silicone implants. To summarize the MR findings of postoperative complications after implantation is helpfull to detect and diagnose complications in clinical work, and avoid the irreversible injury caused by delayed treatment.